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D Dissegna

Publications and source records attributed to D Dissegna.

11 recordsLinked to original sources
PubMed2005

Monitoring of immunosuppressive therapy in renal transplanted patients.

The regulation of the immunosuppressive therapy after kidney transplantation is the most complex aspect of the management of transplanted patients. Every day the transplant clinician is challenged by need to provide a sufficient immunosuppression to avoid or reduce the risk of rejection without exposing the patient to the risk of developing opportunistic infections or malignancy or toxic side effects. The safety and efficacy profile of immunosuppressive therapy is limited within a narrow therapeutic window whose borders are represented by two clinical conditions such as rejection and drug-related toxicity. The availability of several different drugs allows the clinicians to make multiple choices to individualize treatments according to the specific needs of a single patient. Pharmacokinetic monitoring of the immunosuppressive drugs is an important element in the management of these patients but cannot be considered as the unique driving factor and must be integrated with a careful surveillance and evaluation of all drug-related side effects.

Cyclosporine↗
PubMed2001

Practice pattern and treatment options for kidney patients in a single North Italian nephrology center.

The experience and the current practice of a single center located in northern Italy is reported. The center of Vicenza is a self-standing nephrologic unit serving a population of about 300,000 individuals. The overall province counts approximately 800,000 individuals and some of them are referred to our center from peripheral hospitals for renal transplantation and/or particular pathologic conditions. The center offers an integrated approach to the treatment of uremia including hemodialysis (HD), peritoneal dialysis (PD), and renal transplantation. In HD and PD, the most peculiar aspect is the treatment personalization that leads to numerous types of applied therapies and technologies. The policy of the center is based on the belief that the nephrology team has a substantial influence on the outcomes of dialysis patients. A large number of treatment options are available. Special care is placed on the delivery of an adequate amount of dialysis, but the fractional clearance of urea in relation to volume (Kt/V) is seen as a prerequisite and other factors are considered important. Reduction in mortality and morbidity is largely dependent on beginning therapy early in the course of renal treatment. The attainment of appropriate hemoglobin concentrations, good nutrition, good control of calcium and phosphorus metabolism, lipids, and blood pressure, is considered of great importance. Beyond all these factors the time spent by the physician with the patient is considered one of the major factors influencing quality of care. The particularly low mortality of the center (6%/yr) may also be ascribed to a lower incidence of diabetes and other comorbidities.

Delivery of Health Care↗
PubMed2000

Role of antigenemia assay in the early diagnosis and treatment of CMV infection in renal transplant patients.

AIM: CMV antigenemia by direct pp65 antigen detection and quantification was monitored on a weekly basis during the first 3 months after kidney transplantation. SUBJECTS AND METHODS: Preemptive therapy with ganciclovir was started according to the following criteria: any positive antigemia in CMV-NEG subjects, a single determination > or = 30 cell or a two fold increase of positive cells in two consecutive specimens in CMV-POS and continued until pp65 was cleared. Overall, 109 patients were monitored. RESULTS: Among the 24 CMV-NEG patients, 13 (54%) developed a pp65 positive assay without symptoms and were treated. Ten patients remained CMV-infection free and one patient developed late onset (7 months) CMV disease (hepatitis). Among the 85 POS patients 15 (17%) developed a pp65 positive assay and were treated. Two of them developed CMV disease within 7 days of the onset of positive antigenemia and 13 were asymptomatic. The other 70 patients remained CMV-infection free. The interval between transplant and the onset of CMV infection was 39 +/- 13 days in the CMV-NEG group and 64 +/- 20 days in the CMV-POS group (p < 0.001). The peak antigenemia level was 193 +/- 175 cells in the CMV-NEG group and 55+/- 78 cells in the CMV-POS group (p < 0.001). The duration of treatment did not differ in the two groups (22 +/- 7days). A second course of therapy, due to a relapse of asymptomatic infection was performed in 11/13 (85%) treated CMV-NEG patients and in 2/15 (13%) treated CMV-POS patients. CONCLUSIONS: Among the total 28 treated patients, we observed only 6 episodes of mild creatinine increase and 9 episodes of mild neutropenia. In the overall population, we observed 8 systemic infections not related to CMV.

Antigens, Viral↗
PubMed1994

On line filtration of dialysate: structural and functional features of an asymmetric polysulfone hollow fiber ultrafilter (Diaclean).

The endotoxin transfer across dialysis membranes has been investigated using specific in vitro circuits. Backdiffusion and backfiltration have been analyzed and most dialysis membranes have shown to be permeable to LAL positive substances. Synthetic membranes however display the better capacity of retention of these products despite their higher porosity and permeability. For such reason synthetic polysulfone ultrafilters are used as pyrogen filters to obtain ultrapure dialysate. We have investigated the characteristics of a polysulfone ultrafilter named Diaclean and manufactured by Amicon Ireland. The capacity of endotoxin retention has been investigated both in filtration and backfiltration modes on new and used ultrafilters. The capacity of endotoxin adsorption was investigated as well. Used ultrafilters appeared to maintain the retention capacity and the adsorption capacity up to 4 months of use. Only slight differences were noted from the baseline values (p = n.s.). The best adsorption capacity is always displayed by the outer layer of the membrane suggesting its best utilization in back filtration mode with tangential flow. No morphological changes were observed in the used membrane analyzed by scanning electron microscopy.

Diffusion↗
PubMed1993

Short-term clinical study with bicarbonate-containing peritoneal dialysis solution.

OBJECTIVE: The evaluation of the efficacy, adequacy, clinical tolerance, and safety of a new bicarbonate continuous ambulatory peritoneal dialysis (CAPD) solution. DESIGN AND PATIENTS: A 6-week cross-over clinical study in 6 stable CAPD patients was performed. After a control period (2 weeks) with a standard CAPD solution (lactate, 35 mmol/L), a two-chamber bag containing 34 mmol/L of bicarbonate was used for 4 weeks. A breakable valve divided the two chambers, one containing bicarbonate and the other calcium. The two solutions were mixed just before use, thus avoiding the calcium and magnesium carbonate precipitation. RESULTS: No differences between control and study periods were found for blood urea nitrogen, creatinine, total proteins, albumin, total and ionized calcium, phosphate, sodium, potassium, chlorine, and hemoglobin. Blood bicarbonate significantly increased from 21.25 +/- 2.02 to 23.36 +/- 1.15 (p < 0.05) during the study. The peritoneal equilibration tests for urea nitrogen, creatinine, proteins, sodium, potassium, and glucose were slightly reduced during bicarbonate dialysate, but this effect was compensated for by a slight increase of ultrafiltration, thus keeping peritoneal clearances constant. Residual renal function did not change during the study. No side effects occurred during the bicarbonate period. CONCLUSION: A CAPD bicarbonate solution is effective in uremic acidosis correction, does not affect dialysis adequacy, is safe, and well tolerated.

Adult↗
PubMedDate not supplied

[Pregnancy after kidney transplantation. Case load of the Transplantation Center of Vicenza].

BACKGROUND: Pregnancy after kidney transplant has become possible thanks to recent surgical and pharmacological breakthroughs. MATERIALS AND METHODS: We performed a retrospective study including all pregnant women transplanted in our center after 1997. The following variables were analyzed. The type of nephropathy, patient age when dialysis began, patient age at trans-plantation, the time between dialysis and transplantation and the time between transplantation and childbirth. Immunosuppressive therapy, type of delivery, baby's weight and Apgar score were also considered. RESULTS: We followed four pregnancies in three patients who were, respectively, diagnosed with chronic pyelonephritis, post-partum cortical necrosis and immunoglobulin A (IgA) glomerulonephritis (GN). We observed complications in three cases and two pre-term births. In one case, the baby's weight at birth was lower when compared to the gestation age. We did not observe any significant disease in the baby's follow-up. CONCLUSIONS: We concluded that our data were in agreement with those in the literature confirming that pregnancy after kidney transplant, although possible, carries an elevated risk; and therefore, patients have to be referred to highly specialized centers.

Adult↗
PubMedDate not supplied

Cannulation of the internal jugular vein: comparison of the classic Seldinger technique and an ultrasound guided method.

Central venous catheterization allows immediate and easy vascular access for hemodialysis. Accidental arterial puncture is the most frequent complication of central vein cannulation and may occur in up to 8% of cases with the classic Seldinger procedure. We compared the Seldinger technique which implies manual localization of the vascular access, and an ultrasound guided technique, to assess whether the latter is an improvement on the Seldinger procedure.

Catheterization, Central Venous↗