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C Basile

Publications and source records attributed to C Basile.

At least 19 recordsLinked to original sources
PubMed1992

Tumoral calcifications in hemodialysis patients: possible role of aluminum intoxication.

Uremic patients may develop extraskeletal calcifications. Among the latter, periarticular tumoral calcifications (TC) represent massive, multiloculated calcium-phosphate deposits. The aim of this report was to analyze a series of 10 cases of TC in hemodialysis patients who were admitted at the Necker Hospital between 1974 and 1988. They were all male. An increased plasma calcium x phosphorus product was observed in 8 of the 10 patients. Plasma calcium level was increased in only 2 patients. In contrast, hyperphosphatemia was a constant feature in all the patients, as was the absence of an increase in plasma alkaline phosphatase activity. Using the bone histomorphometry technique, osteitis fibrosa of mild degree was observed in 2 patients, of moderate degree in 2 and of severe degree in 2 others. Evidence of aluminum (Al) overload was found in the 8 patients in whom it was searched based on bone histomorphometry, bone histochemistry, bone Al content and increased serum Al levels either in the basal state or after a deferoxamine test. In addition, Al overload was strongly suspected in the 2 remaining patients because of prolonged exposure to Al-contaminated dialysate. Various treatment strategies, including parathyroidectomy (PTx), were undertaken that remained unsuccessful in modifying the course of TC to a significant extent. Remarkably, TC occurred for the first time after PTx in 1 patient and worsened after PTx in 2 others. In conclusion, overt secondary hyperparathyroidism appears not to be an essential prerequisite for TC development in hemodialysis patients, and PTx must not be performed in such patients on the sole basis of the presence of TC.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

HCV infection occupational hazard at dialysis units and virus spread, among relatives of dialyzed patients.

It was the purpose of this study to evaluate the spread of HCV infection among the staff at Dialysis Units and among relatives of anti-HCV-positive hemodialysis patients. 122 health-care workers and 52 relatives were screened for presence of anti-HCV Ab. The control groups consisted of 100 health-care workers from other wards and 30 relatives of anti-HCV-negative subjects. 2.45% of the health-care staff and 5.8% of the relatives were found to be anti-HCV Ab carriers. None of the subjects in the control groups were positive. In conclusion, the results of this study indicate that there is a real possibility of HCV spread through occupational exposure although the corresponding percentage in less than that presumably due to within-the-family contagion by the virus.

Adult↗
PubMed1992

A successful two-step integrated protocol of anti-HBV vaccination in chronic uremia.

A prospective study was performed in 40 chronic uremics which included: (1) the intramuscular administration to all patients of 40 micrograms of a DNA-recombinant vaccine (Engerix-B) at 0, 1, 2, 6 months; (2) an intramuscular booster dose of 40 micrograms at 18 months in patients having an anti-HBs titer greater than 100 mIU/ml at the 7th month (group A); (3) a further intramuscular supplementary dose of 40 micrograms at 12 months (besides that at 18 months) in patients developing an antibody titer less than 100 mIU/ml at the 7th months (group B); (4) an intradermal course of 5 micrograms of vaccine every 2 weeks until the protective titer (greater than or equal to 10 mIU/ml) was achieved, and then every month for a total of 6 months in patients who did not develop a protective titer even after 19 months (group C). At the end of the study, all patients had developed a protective titer: 77.5% after the 4th intramuscular dose, 12.5% after the 5th and 10% after 3.5 +/- 0.5 (mean +/- SEM) intradermal inoculations. The mean antibody titers were 1,461 +/- 98 mIU/ml in group A, 594 +/- 684 in group B and 131 +/- 133 in group C. In conclusion, our two-step integrated protocol gives an anti-HBs protective titer in all our patients.

Female↗
PubMed1991

Use of sedating drugs and neuromuscular blocking agents in patients requiring mechanical ventilation for respiratory failure. A national survey.

OBJECTIVE: To assess current use of sedating drugs and neuromuscular blocking agents in patients requiring mechanical ventilation at US hospitals that participate in the training of pulmonary fellows. DESIGN: Surveys were mailed in September 1990 to the head nurses of medical intensive care units at 265 US hospitals that were listed in an annual guide listing pulmonary fellowship training programs. In the survey, sedating drugs were defined as medications prescribed to treat anxiety, agitation, or sleeplessness. These included opiates, anesthetics, or neuroleptic agents when used for any of these purposes. SURVEY RESPONDENTS: Surveys were received from nurses at 164 hospitals (62% response rate) representing 93 medical schools and 100 pulmonary fellowship training programs. Nearly half of the respondents worked at university hospitals. Most worked as head nurses in medical (70%) or medical-surgical (21%) intensive care units (ICUs). RESULTS: Sedating drugs were given to patients undergoing mechanical ventilation at virtually all the ICUs surveyed, and 36% used these drugs routinely (greater than 70% of patients). Opiates and benzodiazepines were employed most commonly; haloperidol lactate was widely used as well. Intermittent intravenous injection was the preferred method of administration; 62% of the ICUs also gave these drugs by continuous intravenous infusion. Neuromuscular blocking agents were also used at nearly all the ICUs surveyed; however, most gave these drugs to fewer than 20% of patients experiencing respiratory failure. Orders for the use of sedating drugs and neuromuscular blocking agents were written exclusively by house staff at 65% of the ICUs surveyed. CONCLUSIONS: Sedating drugs and neuromuscular blocking agents are widely used for patients requiring mechanical ventilation in ICUs at US teaching hospitals. There is considerable variation in the choice, frequency, and method of administration. Given the expense (up to $1000 a day) and the potential hazards to patients of prolonged deep sedation and paralysis, more research is warranted to determine optimal use of these drugs during mechanical ventilation.

Drug Utilization↗
PubMed1991

Clinical spectrum of accidental hemlock poisoning: neurotoxic manifestations, rhabdomyolysis and acute tubular necrosis.

In the past, hemlock poisoning was only known for its neurotoxic effects; quite recently non-neurological features, consisting of rhabdomyolysis and acute renal failure, have been also described. Here we report our experience with these clinical findings, which we frequently observe in accidental hemlock poisoning. Between 1972 and 1990 we studied 18 patients: 17 of them were poisoned by conline (an alkaloid of Conium maculatim) in Apulia (Italy), and one by cicutoxin (the active principle of water hemlock) in New Mexico (USA). In the non-rapidly-fatal cases we tested myoglobinuria, serum muscle enzymes, and renal function. In the patients with acute renal failure we performed microscopical examination of kidney specimens; immunohistochemistry was carried out to identify myoglobin and actin in tubules. Coniine was detected in urine, serum, or tissues. Neurological features were present in all of our cases: coniine had a curare-like effect on the neuromuscular junction, whereas cicutoxin was convulsant on the central nervous system. In addition rhabdomyolysis was noted in the 17 subjects poisoned by coniine. Acute renal failure was observed in five patients; it was confirmed by histological evidence of tubular necrosis with intratubular deposition of myoglobin and actin released by rhabdomyolysis. Our cases seem to be the first with histopathologically proven acute tubular necrosis in coniine intoxication. In conclusion, in hemlock poisoning neurotoxic manifestations may be accompanied by rhabdomyolysis and acute tubular necrosis; increased awareness of these clinical features is recommended in order to improve the diagnostic and therapeutic procedure.

Adult↗
PubMed1990

Percent reduction in blood urea concentration during dialysis estimates Kt/V in a simple and accurate way.

Urea Kt/V is an accurate tool to estimate the adequacy of hemodialysis (HD) therapy; however, the current methods of calculating Kt/V are too complex for routine clinical use and require great care in order to avoid major inaccuracies. As percent reduction in blood urea concentration during dialysis (PRU) is a function of dialyzer urea clearance, length of dialysis, and urea distribution volume of the patient, it might correlate with Kt/V. Thus, analyzing retrospectively data of 78 studies, we found that the following linear regression equation existed between Kt/V values calculated by means of direct dialysis quantification (DDQ) and PRU values: Kt/V = 0.023 x PRU - 0.284 (r = 0.92). Furthermore, a good correlation existed between Kt/V values measured both by means of DDQ and of the classical algorithm (CA) of the urea kinetic model (UKM) (r = 0.98). Then, a prospective study was started in which 145 Kt/V values calculated by means of the above equation were correlated with the corresponding ones computed by means of a modified algorithm (MA) of UKM, perfectly fitting those generated by CA of UKM. Although the relationship was exponential, it was linear in the clinically important range of PRU between 40% and 70%, corresponding to a Kt/V between 0.64 and 1.33. Furthermore, an excellent correlation (r = 0.96) and no statistically significant difference existed in this range between the two series.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1990

A modified algorithm of the single pool urea kinetic model.

Urea Kt/V, calculated according to the variable volume single pool urea kinetic model (UKM), has been accepted as the yardstick reflecting the adequacy of haemodialysis therapy. However, the classical algorithm of UKM requires great care in dialyser urea clearance (K) measurement in order to avoid major inaccuracies in estimating the urea distribution volume (V). Thus, we suggest a modified algorithm of UKM which avoids the measurement of K. It assumes an arbitrary V value and then calculates kinetically K as a function of the assumed V value. The rationale of the modified algorithm can be derived from the knowledge that the classical algorithm imposes a proportionality ration between K and V: given a particular set of data, a change in the attributed value of K leads to a proportional change in the calculated V value, so that the ratio K/V remains nearly constant. Aims of the study were (1) to validate the modified algorithm by comparing the resulting Kt/V and normalised protein catabolic rate (NPCR) values with the homologous ones obtained using the classical algorithm in a group of 33 patients on thrice-weekly haemodialysis; plasma water urea concentrations were used with the classical algorithm (CApw) and the modified algorithm (MApw); and (2) to verify the possibility of using plasma urea concentrations with the modified algorithm (MAp) instead of the more rigorous plasma water concentrations. NPCR (g/kg per day) was 1.33 +/- 0.05 in CApw, 1.29 +/- 0.05 in MApw and 1.28 +/- 0.04 in MAp. Kt/V was 1.27 +/- 0.03 in CApw, 1.25 +/- 0.03 in MApw and 1.26 +/- 0.03 in MAp.(ABSTRACT TRUNCATED AT 250 WORDS)

Algorithms↗
PubMed1989

Short-term effects of parathyroidectomy on plasma biochemistry in chronic uremia.

Parathyroidectomy (PTx) is indicated in hemodialysis (HD) patients who have severe osteitis fibrosa unresponsive to vitamin D therapy or in whom the latter treatment is contraindicated. Immediately after PTx, plasma immunoreactive parathyroid hormone, calcium and phosphorus concentrations decline abruptly. However, little is known in such patients about the short-term effects of PTx on plasma alkaline phosphatase (AP) activity and plasma aluminum (Al) levels. The present, preliminary study was performed to determine such parameters in 37 HD patients, and to correlate them with data of bone histology. Mean plasma AP activity started to increase after PTx from day 4 onwards. Thus, AP values significantly higher than pre-PTx values were observed at day 7 and 14 (415 +/- 54 vs. 619 +/- 77 and 749 +/- 83 IU/liter, means +/- SEM; N = 37; P less than 0.05 and 0.001, respectively). This increase, in the absence of changes in liver function, was mainly due to the bone-specific iso-AP. Moreover, the degree of increase in plasma AP activity was higher in the subgroup with negative (group I, 21 patients) than in that with positive bone Al staining (group II, 16 patients). However, plasma osteocalcin (BGP) did not change after PTx (N = 8). Basal plasma Al levels were significantly higher in group II both before and two weeks after surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Alkaline Phosphatase↗
PubMed1989

[Severe hyperparathyroidism in 2 uremic patients. Diagnostic and therapeutic difficulties].

We report here the unusually difficult cases of two patients with end-stage renal failure who suffered from severe hyperparathyroidism requiring surgical correction. The first patient had previously undiagnosed primary hyperparathyroidism. A first surgical neck exploration led to the discovery of four glands, paradoxically normal in size and aspect, which were removed. Subsequently, a supernumerary gland was localized in the mediastinum by computerized tomography and removed via sternotomy. After confirming the hypoparathyroid state, parathyroid autotransplantation was performed using cryopreserved tissue. The second patient had five hyperplastic parathyroid glands removed during the first neck exploration, followed by immediate parathyroid autografting. Because of the persistence of severe hyperparathyroidism, forearm autografts were subsequently removed and a sternotomy performed. Both failed to improve parathyroid hyperfunction. Numerous localization procedures remained negative. A repeat surgical neck exploration was performed because of positive double isotope scanning but was of no success in preventing fatal outcome, as were all medical treatments. These observations of two patients illustrate the difficulties in localizing and removing ectopic parathyroid lesions. Even when relying on the presently available powerful diagnostic means, correction of severe hyperparathyroidism may be extremely difficult.

Acute Disease↗
PubMed1988

Hypothalamus-hypophysis and testicular GnRH control of gonadal activity in the frog, Rana esculenta: seasonal GnRH profiles and annual variations of in vitro androgen output by pituitary-stimulated testes.

The binding of a gonadotrophin-releasing hormone (GnRH) long acting analog (GnRHA), D-Ser (But)6,Pro9-NEt GnRH (HOE 766), to pituitary and testicular extracts and the presence of GnRH-like material in testes and hypothalamuses were measured in the frog, Rana esculenta. Also, the cellular localization of immunoreactive GnRH was investigated in testes by immunohistochemical staining. Furthermore, lyophilized preparations of pituitary crude homogenates from animals caught monthly were tested in vitro for their ability to stimulate androgen production by December testes. Satisfactory results on specific 125I-GnRH binding were difficult to obtain in view of its low binding capacity. Moreover, binding in testicular homogenates was of the same order of magnitude (about 2%) as that found in pituitaries. In a cospecific radioimmunoassay for GnRH nonapeptide, both hypothalamic and testicular extracts gave displacement parallel to the standard curve. Immunoreactive GnRH did not significantly fluctuate in hypothalamuses, while it peaked in testes during December and July. Immunoreactive GnRH was evidenced in June and September testes employing immunohistochemical staining. In particular, the interstitial cells and the Sertoli cells were faintly stained. Testes of December animals stimulated by February pituitaries produced larger quantities of androgens as compared with testes stimulated with hypophyseal preparations from the remaining periods of the year. In conclusion, the present results are consistent with the idea that seasonal changes of the hypothalamus-hypophyseal activity play an important role in regulating the hormonal response in vertebrate testes. Moreover, we report that, in addition to rats, GnRH-like material is present in frog testes and for the first time it has been shown that such putative intratesticular material undergoes seasonal fluctuations in a vertebrate.

Androgens↗