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Biomedical subjects

A De Vecchi

Publications and source records attributed to A De Vecchi.

At least 19 recordsLinked to original sources
PubMed1992

Effect of simvastatin in CAPD patients with hypercholesterolemia.

The effect of simvastatin on serum total and HDL cholesterol and total triglyceride levels in 20 hypercholesterolemic patients on CAPD treatment was studied. The drug was given at the initial dose of 10 mg/day which was doubled up to 40 mg/day. Two non-compliant patients stopped the drug in the first week of treatment. One patient had vomiting and stopped simvastatin. One patients reduced the dose from 20 to 10 mg/day because of increase in CPK level. The study was completed in 16 patients. Serum cholesterol decreased from 318 +/- 39 to 208 +/- 34 mg/dl (p < 0.001), triglyceride from 317 +/- 129 to 278 +/- 160 mg/dl and HDL cholesterol from 43 +/- 13 to 35 +/- 11 mg/dl. The effective does was 10 mg/day in 4 cases, 20 mg/dl in 7 and 40 mg/dl in 5. In CAPD patients, simvastatin is safe and effective in lowering serum cholesterol. The clinical significance of the decrease in HDL cholesterol and its possible effect on clinical outcome are still unknown.

Anticholesteremic Agents↗
PubMed1991

Exit-site and tunnel infections in continuous ambulatory peritoneal dialysis patients.

One hundred two exit-site infections (ESI) were diagnosed in 63 of 163 (38.6%) patients, with an incidence of one episode every 23.7 patient-months in patients with a history of ESI, whereas in the overall continuous ambulatory peritoneal dialysis (CAPD) population the incidence was one episode every 48.7 patient-months. In diminishing order of frequency, the bacteria isolated were Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosa, and Escherichia coli. The probability of remaining free of ESI was 72% at 1 year and 45% at 5 years. The ESI that led to catheter removal were due to S aureus and gram-negative rods. In 13 (48%) of 27 S aureus ESI unresponsive to antibiotics and local care, deroofing and outer cuff shaving completely resolved the ESI. Despite this treatment, the catheters of the remaining 14 patients had to be removed because of peritonitis associated with the tunnel infection. In conclusion, ESI is a major cause of CAPD failure. In our series, shaving the cuff as a rescue treatment was effective for almost 50% of the patients with antibiotic-resistant S aureus ESI.

Bacterial Infections↗
PubMed1991

Nutritional assessment of continuous ambulatory peritoneal dialysis patients: an international study.

We examined the nutritional status of 224 patients from six centers in Europe and North America to assess the incidence of protein-energy malnutrition. A "subjective nutritional assessment" was made, using 21 variables derived from history and clinical examination, or anthropometry and biochemistry. Eighteen patients (8%) were severely malnourished, 73 (32.6%) were mildly to moderately malnourished, and 133 (59.4%) did not show evidence for malnutrition. There was a higher incidence of mild to moderate malnutrition in diabetics than in nondiabetics. A statistical analysis identified 12 variables, seven objective and five subjective, that correlated with subjective nutritional assessment. Actual intercenter differences for the incidence of malnutrition were related to patient age, nutritional status at the commencement of continuous ambulatory peritoneal dialysis (CAPD), the length of time on CAPD, and residual renal function. Variables that were most frequently correlated with subjective nutritional assessment and with one another included plasma albumin, mid-arm muscle circumference (MAMC), weight loss, and the clinical judgement of muscle wasting and loss of subcutaneous fat. Loss of residual renal function correlated with muscle wasting and months on CAPD. Our data identified differences between the two sexes. In women there was a trend for more anorexia, greater weight loss from muscle wasting, and a larger decrease in albumin, whereas in men there was a more gradual decrease in nutritional status. Loss of residual renal function contributed to anorexia and symptoms of severe malnutrition.

Adolescent↗
PubMed1991

Gemfibrozil in CAPD patients.

Gemfibrozil was given at a daily oral dose of 600 mg to 28 CAPD patients with serum triglyceride levels higher than 200 mg/dl, after 2 months of low fat low calorie diet. Eleven patients dropped out from the study due to spontaneous withdrawal of the drug or to intercurrent hospitalization. The 17 patients who completed the study showed a significant decrease in serum total (434.6 +/- 207.9 to 237.5 +/- 81.6 mg/dl, p 0.003), VLDL (268.8 +/- 17.8 to 109.2 +/- 66.9 mg/dl, p less than 0.005) and LDL (152.9 +/- 34.6 to 119.2 +/- 30.7 mg/dl, p = 0.004) triglyceride. Serum VLDL cholesterol increased from 108.7 +/- 54.1 to 59.9 +/- 29.0 mg/dl, p = 0.003. Serum HDL cholesterol decreased from 25.4 +/- 4.8 to 35.3 +/- 6.3 mg/dl (p less than 0.001). Apo A1 increased from 117.8 +/- 16.7 to 130.8 +/- 16.7 mg/dl (p less than 0.001) and Apo B increased from 173 +/- 26.7 to 137.8 +/- 21.9 mg/dl (p less than 0.001). No clinical or laboratory side effect was observed in the patients who completed the study. Therefore dropouts were due to the poor patients' compliance rather than to the severity of side effects.

Aged↗
PubMed1991

A multicenter, selection-adjusted comparison of patient and technique survivals on CAPD and hemodialysis.

Four hundred and eighty CAPD and 373 HD patients started regular dialysis treatment between 1981 and 1987 in 6 dialysis centers. The CAPD patients were 6 years older, on average, than the HD patients and had more complicating conditions (43.3% with 3 or more coexisting risk factors versus 28.9% with coexisting complications). The 7-year patient survival rate was not significantly different. Cox's proportional hazards regression showed that age, cardiovascular disease, cerebrovascular disease, peripheral vascular disease, diabetes, malignancy and multisystem disease had significant adverse effects on patient survival. After correcting for the influence of these factors, no significant differences in patient survival were seen. However, after 53.5 years of age, the increase in the risk of death was significantly higher in HD than in CAPD patients. Technique survival was significantly different in the 6 centers and was better for HD than for CAPD. There was no statistically significant difference between CAPD and HD technique survival when peritonitis was eliminated as a cause of failure. Based on this 7 year analysis, CAPD would appear to be an excellent alternative to HD.

Female↗
PubMed1990

Response of renal transplanted patients to oral calcium load.

In a previous study we demonstrated that cyclosporin-treated renal transplanted patients have a reduced 1,25(OH)2D3 synthesis in comparison with azathioprine-treated transplanted patients. To assess the impact of this defect on intestinal calcium transport we compared the plasma calcium variation and the urinary calcium excretion in 14 cyclosporin-treated and in 12 azathioprine-treated patients, in fasting conditions and 4 hours after an oral calcium load (1 g). In ten cyclosporin patients we also correlated cyclosporin plasma values with plasma 1,25(OH)2D3 values before and after a 25(OH)D3 oral load. After the oral calcium load, plasma and urinary calcium increased significantly in the azathioprine group, while remaining unchanged in the cyclosporin group. A negative correlation between plasma concentrations of cyclosporin and the increment in 1,25(OH)2D3 after 25(OH)D3 oral load was also observed. Thus, our data suggest that cyclosporin impairs 1-alpha hydroxylase activity and alters the response to an oral calcium load.

Adult↗
PubMed1990

Long-term incidence of peritonitis in CAPD patients treated by the Y set technique: experience in a single center.

Our experience of peritonitis in 156 patients over an 8-year period represents 186 episodes of peritonitis and 4,964 patient-months of CAPD. The incidence of peritonitis was significantly greater (1 episode every 8.6 patient-months) when the Oreopoulos technique was used and dropped to 1 episode every 43.3 patient-months when the Y set system was used. Of the 109 patients using the Y set system, 88 (80.7%) never had episodes of peritonitis, whereas only 7 (16.7%) of the 42 patients using the Oreopoulos technique were free of peritonitis. For 23 patients shifted from the Oreopoulos to the Y set technique, the incidence of peritonitis dropped from 1/9.8 to 1/35.2 episodes/patient-months.

Bacterial Infections↗
PubMed1990

Staphylococcus aureus exit-site and tunnel infection in CAPD.

Fifty-six S. aureus episodes of catheter exit-site tunnel infections were diagnosed in 40 out of 163 patients treated by CAPD for 30 +/- 22 months, with standard double-cuff Tenckhoff catheters. The rate of infection was 1 episode every 29 patient/months. Local care and antibiotic therapy were effective in 52% of the cases. Whereas in 29 episodes in which the medical therapy failed to eradicate the infection the entire area of granulation tissue and cellulitis was excised then the outer dacron cuff was shaved from the silicone catheter. With this treatment 13 episodes (48%) were cured while, in the remaining 14 patients the catheters were removed because of peritonitis in 10; and for failure to eradicate the infection in 4.

Catheters, Indwelling↗
PubMed1990

Clinical significance of peritoneal dialysate IgG levels in CAPD patients.

To assess the normal range and the clinical significance of peritoneal IgG, the levels of these proteins were measured in 24 hour dialysates of 69 patients. The mean + SD of IgG levels was 7.2 +/- 4.3 mg/dl. Two patients had peritoneal IgG concentrations below and 6 above the mean +/- SD range. There were no significant correlations between peritoneal IgG levels and sex, previous hemodialysis, age, time of dialysis, number of peritonitis or estimated daily protein intake. In 29 of these patients dialysate IgG levels measured again one year later did not show significant differences between the first and the second determination of IgG (from 6.3 +/- 3.3 to 6.6 +/- 3.2 mg/dl), but changes of 10% or more were observed in 14 of these patients. Our data show no relation between peritoneal IgG and peritonitis episodes. Therefore by these results dialysate IgG cannot be used as a reliable index to decide which patients are at high risk for peritonitis.

Cross-Sectional Studies↗
PubMed1989

Beta-2 microglobulin in patients on peritoneal dialysis and hemodialysis.

Serum beta 2 microglobulin (beta 2 mu) levels were determined in 62 patients on chronic dialysis, divided according to the type of dialysis--cuprophane hemodialysis, chronic ambulatory peritoneal dialysis (CAPD), or CAPD started after 76 +/- 47 months on cuprophane hemodialysis--and to residual urine output greater than 400 mL/day or less than 10 mL/day. In addition, for patients on CAPD, peritoneal excretion, peritoneal clearance, and urinary excretion of the protein were determined. In anuric patients serum beta 2 mu levels were significantly higher in HD than in CAPD. In patients with residual urine output, serum concentrations of the microprotein were similar in HD and in CAPD. Significant differences were observed in beta 2 mu serum levels and peritoneal clearances in patients switched to CAPD from hemodialysis as compared to those starting with CAPD. Peritoneal clearances of the microprotein was slightly and non-significantly greater in patients with urine output than in anuric patients.

Amyloidosis↗
PubMed1989

Phosphatidylcholine administration in continuous ambulatory peritoneal dialysis (CAPD) patients with reduced ultrafiltration.

To evaluate the possible role of oral phosphatidylcholine administration in improving peritoneal ultrafiltration sixteen continuous ambulatory peritoneal dialysis (CAPD) patients with a reduced ultrafiltration rate (less than 500 mL/4 h after a standard 3.86% glucose exchange) were studied. Three patients spontaneously stopped phosphatidylcholine due to gastric side effects. Three out of the remaining 13 patients showed a mild increase of standard ultrafiltration, which was not followed by any increase in daily dialysate output. No differences in glucose, sodium, potassium, urea and creatinine equilibration curves were seen. In conclusion, in our series oral phosphatidylcholine is not free of side effects, and its efficacy in improving ultrafiltration is scanty, with no clinical relevance in increasing daily ultrafiltration.

Administration, Oral↗
PubMed1979

Comparison between immunofixation and crossed immunoelectrophoresis for the detection of C3 activation products.

C3 breakdown products were measured in 51 fresh and stored sera and/or EDTA plasma samples from 18 healthy subjects, 8 patients affected by essential mixed cryoglobulinaemia, and 15 patients with miscellaneous glomerulonephritis, by simultaneous crossed immunoelectrophoresis and immunofixation. C3 splitting products, as determined by both methods compared well, and showed a highly significant correlation. The advantages and reliability of these two methods are discussed. Immunofixation seems to be the most suitable for routine use in clinical practice, being less expensive and more rapid to perform.

Complement C3↗
PubMed1978

Lipid disorders in renal transplant recipients.

Plasma cholesterol, triglyceride, lipoprotein and phospholipid levels were higher in 76 transplant recipients than in normal age-matched controls. 22 patients exhibited a normal lipid pattern; 12 a type IIa, 12 a type IIb, and 30 a type IV hyperlipidemia. Lipid abnormalities were not related to serum creatinine, parathyroid hormone (PTH), serum albumin, plasma glucose, transplant age, relative body weight or steroid administration schedule. Only plasma triglyceride level was related to mean prednisone dosage. In order to reduce the apparent cardiovascular risk posed by these changes in plasma lipid concentration, hypocaloric diet was administered to 16 patients with hypertriglyceridemia or mixed hypertriglyceridemia and hypercholesterolemia. With these dietary measures, plasma lipid concentrations returned to normal and remained stable during the period of observation (6--18 months).

Adolescent↗
PubMed1978

Serum complement pattern in essential mixed cryoglobulinaemia.

In twenty-six patients affected by essential cryoglobulinaemia, 188 determinations of serum complement components (SCC) were made. A peculiar pattern was observed which was characterized by: (a) low levels of early components (Clq, Cls and C4), (b) normal levels of C3 and high concentrations of late components (C5, C9) and (c) CH50 values significantly lower than normal. No relationship could be observed between early SCC and C3 levels. Thirty-three crossed immunoelectrophoreses were performed in thirteen patient's blood samples. The C3c peaks were not different from normal. Follow-up data (156 serum samples from twenty-four patients) during a 6-40 month period showed a non-homogeneous SCC behaviour. However, no relationship was found between the complement concentrations and clinical score. These findings suggest that SCC abnormalities are related to a complement hyposynthesis, which could be caused by a reduced C2 production or by a negative feedback effect of active components or their fragments.

Complement C3↗
PubMed1976

Primary proximal renal tubular acidosis; A therapeutical approach and long term follow-up.

This paper reports a case of proximal renal tubular acidosis followed during 4 years, in a 4-year-old girl. High doses of alkali could not be administered owing to gastric intolerance of the patient; diuretic therapy carries the risk of causing severe dehydration or hypotension. We administered such a dose of NaHCO3 to obtain a normal blood pH--with persistent hyperventilation-, subnormal bicarbonatemia, and acid urine. This treatment could cause an improvement of rickets, growth and laboratory data. At present, the biochemical data, including urinary excretion of bicarbonate with normal bicarbonatemia, are normal; this indicates a spontaneous recovery of the syndrome. We think that low doses of alkali are useful in the transient form of proximal renal tubular acidosis to prevent bone lesions and failure to thrive. But even in the irreversible form of this syndrome--when high alkali doses and diuretics cause dangerous effects--this therapy may be useful to treat some symptoms.

Acidosis, Renal Tubular↗