PubMed Health⌕ Search

Biomedical subjects

C Gandolfo

Publications and source records attributed to C Gandolfo.

At least 37 records · Page 2Linked to original sources
PubMed2000

Ultrafiltration with icodextrins in continuous ambulatory peritoneal dialysis and automated peritoneal dialysis.

Icodextrins (Icos) produce constant linear ultrafiltration (UF). This effect allows Icos to replace glucose during long dwells in continuous ambulatory peritoneal dialysis [CAPD (nighttime)] and automated peritoneal dialysis [APD (daytime)]. However, the effectiveness of Icos in producing UF (IcoUF) is limited by lymphatic reabsorption, whose extent depends partly on posture and physical activity. This paper aims to assess whether the difference in posture and physical activity between daytime dwells in APD and nighttime dwells in CAPD affects IcoUF. Patients undergoing first treatment were retrospectively examined. Ten patients were on CAPD [4 males, 6 females; average age, 73.0 +/- 13.4 years; body surface area (BSA), 1.63 +/- 0.21 m2; total volume per day, 5.6 +/- 1.9 L], and ten were on APD (7 males, 3 females; average age, 67.7 +/- 9.8; BSA, 1.75 +/- 0.22 m2; total volume per night, 10.5 +/- 0.9 L). Ultrafiltration was assessed for seven consecutive days preceding a peritoneal equilibration test (PET) and collection of diuresis. In both groups, 3 patients had no diuresis, and the difference between CAPD and APD was not significant (625 +/- 762 mL vs 780 +/- 878 mL). Moreover, no significant difference was seen in 4-hour dialysate-to-plasma creatinine (D/P) between CAPD (0.65 +/- 0.12) and APD (0.64 +/- 0.05). Dwell times with Icos were shorter in CAPD than in APD (11.5 +/- 1.8 hours vs 14.8 +/- 0.5 hours, p < 0.0005), but the fill volume was not significantly different (1760 +/- 286 mL vs 1790 +/- 249 mL). Water excretion owing to diuresis and dialysis [total water excretion (TWE): 1619 +/- 497 mL CAPD vs 1762 +/- 736 mL APD] and dialytic UF (363 +/- 443 mL CAPD vs 748 +/- 479 mL APD), which is not linked to Icos, were not significantly different between the two groups. The IcoUF and the percentage of IcoUF to TWE were significantly higher in CAPD compared to APD [631 +/- 253 mL (44% +/- 27%) vs 234 +/- 215 mL (19% +/- 19%), p < 0.001 (p < 0.05)]. In conclusion, an upright posture and physical activity seem to produce less IcoUF in APD despite the longer dwell. These factors could, indeed, produce greater intraperitoneal pressure, resulting in increased lymphatic reabsorption during a daytime dwell.

Aged↗
PubMed1999

Transcranial Doppler detection of microembolic signals: a review.

Transcranial Doppler detection of microembolic signals has been described in several clinical conditions such as carotid stenosis, prosthetic heart valves, acute stroke, and carotid surgery. The importance of these events for clinical decision-making is still a matter of debate. The authors review the literature and report their personal experience on the clinical significance of microemboli detection.

Arterial Occlusive Diseases↗
PubMed1999

Status migrainosus: an unusual presentation of a brain abscess.

Status migrainosus and brain abscess are uncommon complications of migraine and infectious diseases, respectively. We describe a woman with a history of migraine with aura but without any history of a pyogenic infectious process, who suffered status migrainosus as the sole manifestation of a brain abscess.

Brain Abscess↗
PubMed1998

Prevalence of microembolic signals in patients with different types of mono-leaflet and bi-leaflet prosthetic heart valves.

Microembolic signals (MES) have been described in patients with different types of prosthetic valves. The aim of our study was to compare prevalence of MES in patients with mono-leaflet and bi-leaflet valves, and to correlate them with different clinical and echocardiographic parameters. We evaluated 42 patients, 15 with mono-leaflet and 27 with bi-leaflet valves, with 30-minute bilateral simultaneous transcranial Doppler monitoring for the identification of MES. All patients performed blood testing for international normalized ratio (INR), color-coded duplex of supra-aortic vessels, and echocardiography. Eighteen patients (43%) showed MES; 61% of MES were detected bilaterally, 17% only on the left and 22% only on the right middle cerebral artery (MCA), with no interhemispheric difference. MES did not correlate with patient's age, echocardiographic parameters, INR, presence of atrial fibrillation, or site of valve replacement. One (7%) of the 15 patients with mono-leaflet valves had MES, as opposed to 17 (63%) of the 27 with bileaflet valves (p=0.0003). Patients with bileaflet valves and MES had valves of older implantation and, only for aortic valves, larger valve size.

Adult↗
PubMed1998

Calculation of Kt/V and creatinine [correction of creatine] clearance in APD.

The calculation of Kt/V and creatinine clearance per 1.73 m2 of body surface area (CrCl/1.73 m2 of BSA) varies according to whether the post- or pre-nightly dialysis treatment (NDT) values of the serum urea (sUrea), serum creatinine (sCreat), and body weight (BW) parameters are used. The purpose of this paper is to determine the difference between Kt/V and CrCl/1.73 m2 of BSA, calculated using the pre- and post-NDT values, and any correlation of such differences with different automated peritoneal dialysis (APD) methods. We took into consideration patients on APD treated using the tidal method with four different techniques: NTPD (9 patients; no daytime dwell), NTPD-1 (12 patients; one daytime dwell of 4-7 hours), CTPD (10 patients; one daytime dwell), and CTPD-2 (8 patients; two daytime dwells). Body water (V) and body surface area (BSA) were calculated using the Watson and Du Bois formulas. The percentage difference between pre- and post-NDT using the various methods is not statistically significant, while all the post-NDT parameters are significantly lower than the pre-NDT parameters. Since this difference is greater for sUrea (8.8%) and V (1.1%) than for sCreat (4.1%) and BSA (0.8%), the nightly Kt/V variation (11.2%) is greater than the nightly CrCl/1.73 m2 of BSA variation (5.2%). These variations do not differ significantly among the various methods. For APD, therefore, increase is to be expected in the CAPD targets of 10% and 5% respectively for Kt/V and CrCl/1.73 m2 of BSA calculated using the post-NDT values of sUrea and sCreat and the pre-NDT value of BW.

Aged↗
PubMed1997

Role of transcranial Doppler and stump pressure during carotid endarterectomy.

BACKGROUND AND PURPOSE: The aim of our study was to clarify the pathophysiology of perioperative cerebral complications during carotid endarterectomy in our series. METHODS: By means of transcranial Doppler ultrasonography and stump pressure measurement, we monitored 112 patients who underwent carotid endarterectomy under general anesthesia for symptomatic or asymptomatic severe carotid stenosis. RESULTS: Of 18 patients who underwent carotid endarterectomy with intra-arterial shunt, 2 (11.1%) developed an ischemic stroke. Of the other 94 patients, one suffered a nucleocapsular hemorrhage and 5 had cerebral ischemic complications. In these 5 patients, the duration of clamping was significantly longer (mean +/- SD, 16.4 +/- 1.1 versus 12.7 +/- 2.6 minutes; P = .0019), and the decrease of middle cerebral artery mean velocity on clamping was significantly greater (mean +/- SD, 56.4 +/- 4.9% versus 28.8 +/- 20.2%; P = .0031), while stump pressure was not significantly different. Microembolic signals were recorded in 70 patients (62.5%) and were not associated with cerebral ischemic complications. The 7 patients who developed cerebral ischemic complications had a significantly higher percentage of stenosis in the contralateral internal carotid artery (mean +/- SD, 82.0 +/- 17.8% versus 29.3 +/- 36.4%; P = .0018). CONCLUSIONS: The results of our study suggest that the major complications of carotid endarterectomy may be due to hemodynamic factors. Stump pressure alone is not a reliable indicator of hemodynamic changes that predict cerebral ischemia. Particulate microembolism may cause more subtle changes in cerebral parenchyma, but further studies are needed to clarify this point.

Aged↗
PubMed1997

Microembolic signals with serial transcranial Doppler monitoring in acute focal ischemic deficit. A local phenomenon?

BACKGROUND AND PURPOSE: The occurrence of microembolic signals (MES) in patients with transient ischemic attack (TIA) or stroke has already been described, but the diagnostic and prognostic value of this finding is still debated. METHODS: We evaluated 90 consecutive patients admitted for their first hemispheric TIA or ischemic stroke within 72 hours of onset. All of them underwent 30-minute bilateral transcranial Doppler monitoring of middle cerebral arteries, within 72 hours of onset. The monitoring was repeated after an additional 24 hours and after 7 days. We then classified the episodes in the following etiologic categories: cardioembolic, atherothrombotic, small-vessel disease, mixed cases, unknown origin, and other causes. RESULTS: We included 75 patients, with a mean interval of registration of 32.04 +/- 19.39 hours. There were 9 patients with MES (12%). All MES were recorded only on the symptomatic middle cerebral artery, and the majority were recorded during the first or the second registration. No statistically significant difference was found in risk factors and hematologic parameters. Five patients (56%) had atherothrombotic episodes, 3 patients (33%) had cardioembolic episodes, and 1 patient (11%) had a protein S deficit. No patient with MES had small-vessel disease (P = .01). CONCLUSIONS: MES are an infrequent finding in patients with TIA or ischemic stroke within 72 hours of onset, but they can be recorded more easily with serial registration. In our patients, MES were found only on the symptomatic middle cerebral artery and were present in atherothrombotic and cardioembolic episodes but not in small-vessel disease.

Acute Disease↗
PubMed1996

Bilateral ophthalmoplegia: an unusual sign of the top of the basilar artery syndrome.

Bilateral ophthalmoplegia may be an unusual sign of vertebrobasilar ischemia. We report the cases of two patients (75 and 73 years old), who suddenly developed drowsiness, bilateral ophthalmoplegia with bilateral ptosis and mild right hemiparesis. In both patients, MRI revealed bilateral thalamic and midbrain infarcts, ECG showed the presence of atrial fibrillation and Doppler study of the extracranial and intracranial vertebral arteries found no significant alterations. Ischemia involving the midbrain and thalamic paramedian regions may cause bilateral ophthalmoplegia and consciousness disturbances. In these two cases, the most plausible etiologic mechanism was cardiac embolism, and the prognosis for bilateral ocular palsy was poor.

Aged↗
PubMed1996

Value of early variables as predictors of short-term outcome in patients with acute focal cerebral ischemia.

Reliable, simple and safe criteria are needed for the early prediction of short-term outcome in patients with acute ischemic stroke. The aim of our study was to evaluate, in terms of their individual and combined power, the prognostic value of a few widely available clinical and instrumental variables obtained during the acute phase. The study involved 351 consecutive patients who were examined within 48 hours of their first ischemic stroke. Eight variables were chosen: age, initial level of consciousness, limb paresis, arterial blood pressure, glycemia, the results of electrocardiography and electroencephalography, and the infarct size revealed by computed tomography. Mortality and disability were evaluated on Day 30, when the variables that significantly correlated with disability were the severity of limb paresis, electroencephalographic abnormalities, infarct size and (less significantly) the level of consciousness and hyperglycemia. There was no statistical correlation with blood pressure. Logistic analysis confirmed only infarct size, the severity of limb paresis and electroencephalographic abnormalities as independent variables. The variables that significantly correlated with early death were the severity of limb paresis, infarct size, electrocardiographic abnormalities, the level of consciousness, electroencephalographic abnormalities and hyperglycemia. More intriguingly, logistic analysis confirmed only the electroencephalographic and electrocardiographic abnormalities as independent variables. The predictive prognostic value of limb paresis, infarct size, the level of consciousness and hyperglycemia is well known, but we would like to stress the fact that only a few independent variables are predictive of early death (electroencephalographic and electrocardiographic abnormalities) and poor recovery (infarct size, the severity of limb paresis, electroencephalographic abnormalities). The prognostic value of electroencephalography may express the potential involvement of dynamic non-structural phenomena, such as penumbra ischemica and diaschisis.

Adult↗
PubMed1996

Asymptomatic cerebral infarctions in patients with ischemic stroke.

We studied 383 consecutive patients with stroke and ischemic lesions on CT scan for the presence of symptomatic cerebral infarction (SCI) and asymptomatic cerebral infarction (ACI). We evaluated risk factors as well as volume, site and number of the lesions. ACIs occurred in 34% of the cases (130/383); 88% of ACIs were lacunes and internal borderzone infarctions, with a volume of less than 2 ml. Larger infarctions were asymptomatic in 27 patients (20.8%); 114 (68.7%) out of 166 patients with two or more SCIs (68.7%) had one or more ACIs. Infarctions in the lateral middle cerebral artery (MCA) territory were SCIs, in the medial MCA territory ACIs. Independent risk factors for ACI were age above 70 years and smoking; cardioembolism prevailed in SCI, small vessel disease in ACI; high levels of disability prevailed in SCIs.

Aged↗
PubMed1996

Compliance study in peritoneal dialysis using PD Adequest software.

Poor compliance in peritoneal dialysis (PD) is a significant cause of dropout and morbidity. PD Adequest software, which, through a mathematical model, predicts the effect of the dialysis prescription on the basis of the peritoneal transport, may be used to identify the noncompliant patient. Fifty patients from two dialysis centers, aged 65.9 +/- 1.5 years and on PD for 28.6 +/- 4.7 months, were studied. A peritoneal equilibration test (PET) was carried out and 24-hour urine and dialysate were collected. Total weekly creatinine clearance (CrCl, L/week/1.73 m2) was calculated, as well as the glomerular filtration rate [(GFR), mL/min, mean CrCl and urea nitrogen clearance (UNCI)]. The dialytic schedules used were then introduced into the program and the parameters were recalculated using the software model. Nine patients considered noncompliant from their case histories were used to assess the differences of reference between expected and measured values. The control group was significantly different from the noncompliant group in the percentage of the CrCl and the serum creatinine (sCR) differences. The noncompliance threshold value was calculated from the mean of the lower 95% confidence interval of the compliant group and the higher one of the noncompliant group (-5.3%) for CrCl and vice versa for sCR (+10%), which behaved to the contrary. Reassessing the patients, 11 (22%) were identified as probably noncompliant.

Aged↗
PubMed1996

Normalization of protein equivalent of nitrogen appearance and dialytic adequacy in CAPD.

Caloric-proteic malnutrition is frequently encountered in peritoneal dialysis and is associated with an increased risk of morbidity and mortality. Our paper aims to assess any greater reliability of protein equivalent of nitrogen appearance (PNA) normalization to desirable body weight (dBW) compared to actual body weight (aBW) and resulting implications for the relationship between dialytic adequacy and protein intake in continuous ambulatory peritoneal dialysis (CAPD). We studied 36 patients on CAPD, 24 male and 12 female (aged 66.6 +/- 10.2 years, 24 +/- 29 months on dialysis), collecting dialysate and urine over 24 hours (126 samples) to calculate the PNA according to Randerson and the total weekly KT/V. The total body muscle mass (TBMM) was calculated by anthropometry and the dBW according to Metropolitan Life Insurance tables. Finally, PNA was normalized to aBW (aPNA, g/kg/day) and to dBW (dPNA, g/kg/day). Average aBW proved to be higher than dBW (66.0 +/- 11.1 vs 59.8 +/- 6.9 kg, p < 0.0001) and aPNA lower than dPNA (0.96 +/- 0.31 vs 1.08 +/- 0.3 g/kg/day, p < 0.005). Compared to aPNA, dPNA correlates better with both blood urea nitrogen (BUN) (R2 = 0.702 vs 0.614) and KT/V (R2 = 0.348 vs 0.306). The TBMM is higher in the group with dPNA > or = 1.0 vs < 1.0 g/kg/day (25.5 +/- 0.6 vs 23.1 +/- 0.7 kg, p < 0.02) while, paradoxically, it is lower in patients with aPNA > or = 1.0 vs < 1.0 g/kg/day (22.8 +/- 0.8 vs 25.4 +/- 0.6 kg, p < 0.01). The KT/V of the patients with dPNA < 0.8, 0.8-1.2 and > 1.2 g/kg/day proved to be different (1.52 +/- 0.06 vs 1.80 +/- 0.03 vs 2.04 +/- 0.04, p < 0.005). On analysis of the linear regression, dPNA = 1.0 and 1.2 g/kg/day corresponds to KT/V values of 1.7 and 2.05, respectively. We consider dPNA to be more suitable then aPNA for the correct assessment of protein intake, and a weekly KT/V of 1.7-2.05 as being sufficient to guarantee satisfactory dPNA.

Adult↗
PubMed1995

Prevalence and outcome of symptomatic carotid lesions in young adults. National Research Council Study Group.

OBJECTIVE: To estimate the prevalence and outcome of symptomatic internal carotid artery lesions in young adults. DESIGN: Multicentre hospital based observational study with five year follow up. SETTING: Seven neurological departments in northern and central Italy. SUBJECTS: 240 patients (115 men) aged 15-44 with a recent transient ischaemic attack or stroke in the carotid territory. MAIN OUTCOME MEASURES: (a) Prevalence of symptomatic internal carotid artery stenosis or occlusion detected by continuous wave Doppler ultrasonography at entry; (b) incidence rates of cerebral, cardiac, and non-vascular death; non-fatal stroke; and non-fatal myocardial infarction. RESULTS: Carotid stenoses of 50-99% and occlusions were found in 38 patients (15.8%). Both conditions were significantly more frequent in patients aged over 35 and in those with hypertension, diabetes mellitus, and stroke at entry. The standardised mortality ratio at five years was 10.5 (95% confidence interval 5.0 to 19.3). Survival of patients with stenoses of 0-49% and occlusions was significantly better than that of patients with stenoses of 50-99%. Carotid stenosis of 50-99% was an independent predictor of death (hazard ratio 7.9; 95% confidence interval 2.2 to 29) and non-fatal stroke (hazard ratio 7.4; 1.5 to 37.4). CONCLUSIONS: The prevalence of carotid stenosis or occlusion in young adults after a cerebrovascular event is low. Though patients with high grade symptomatic carotid stenosis are at risk of non-fetal and fetal events, patients with internal artery occlusion apparently have a benign prognosis.

Adolescent↗
PubMed1995

Role of automated peritoneal dialysis within a peritoneal dialysis program.

We wished to assess the impact of automated peritoneal dialysis (APD) on the peritoneal dialysis (PD) program. From November 1981 to December 1993, 112 patients were started on hemodialysis (HD) as first treatment and 88 on PD [continuous ambulatory peritoneal dialysis (CAPD): 78, APD: 10]; respective average ages were 61 +/- 14 and 62 +/- 13 years. To December 1985, APD was used as first treatment of PD in 1/29 patients (3.4%), while subsequently, on the basis of a clinical and social-aptitude assessment protocol, it was used in 9/59 patients (15.2%) with PD indication and CAPD contraindications (work: 2 patients, partner required: 7 patients). Of the patients who interrupted CAPD, APD was used in 9/21 patients (reason: social aptitude, 28.6%; clinical, 71.4%). Technique survival after 5 years proved no different in HD versus PD (87% vs 82%, p = NS), whereas in HD versus CAPD it was different (87% vs 62%, p < 0.025). The incidence of peritonitis in APD and CAPD with the Y-set was comparable (1/37 vs 1/40 episode/patient-months), while germ distribution was different (p < 0.001) with Staphylococcus epidermidis prevailing in APD (59%). Based on our experience, APD may extend method acceptance criteria and reduce the technique dropout rate in PD; however, connection technique may need to be improved in order to reduce the risk of peritonitis from exogenous contamination.

Automation↗
PubMed1995

Hematocrit has no effect on peritoneal transport indices.

To assess the effect of hematocrit (Hct) on peritoneal transport indices (PTi), we studied the relationship between Hct (mean 28.1 +/- 5.1%, range 19.1-41.3%) and PTi with 118 peritoneal equilibration tests (PETs; 270 min, 1.36%) on 52 stable patients on peritoneal dialysis. Furthermore, considering a Hct 30% as ideal in peritoneal dialysis (PD), 14 patients who had performed a PET both with a Hct <30% and > or = 30% were checked for any variations in the PTi and blood pressure. We analyzed the subsequent PTi: ultrafiltration; creatinine (Cr) and blood urea nitrogen (BUN) clearance and mass transfer area coefficient (MTAC); 120, 240, and 270 min Cr D/P, UN D/P and glucose D/D0. Linear regressions between Hct and the PTi (118 PETs) did not prove statistically significant. The analysis of the PTi in 14 patients who had performed a PET with both a Hct < 30% and > or = 30% did not prove statistically significant, and no change in blood pressure was demonstrated. We do not consider Hct to have a significant influence on PTi.

Aged↗