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Biomedical subjects

D Docci

Publications and source records attributed to D Docci.

At least 37 records · Page 2Linked to original sources
PubMed1991

[Radiologic and clinical aspects of osteoarticular amyloidosis caused by dialysis].

Many long-term (greater than 60 months) hemodialysis patients develop a severe osteoarticular disease, called "dialysis arthropathy", which is characterized by the deposition in bone and synovia of a new type of amyloid made mainly of beta 2-microglobulin. In the present study, 31 patients (17 males, 14 females; age 54.1 +/- 13 years), undergoing chronic hemodialysis for 60-125 months, were examined for dialysis arthropathy by means of clinics and of radiological investigations (conventional radiography and computed tomography). Sixteen patients (51.6%) had radiographic evidence of dialysis arthropathy: geodes (shoulders, 12 cases; wrists, 11; hips, 2; knees, 2) and/or destructive arthropathies (cervical spine, 13 cases, dorsolumbar spine, 2; hands, 2; hips, 1). Within 24 months, these lesions were found to progress slowly in the majority of cases. In the diagnostic process, CT should be employed in the study of spine, shoulders and hips when the lesions have not been sufficiently demonstrated by conventional radiography in the presence of evident clinical signs. Patients with dialysis arthropathy had undergone dialysis for longer periods than those without it (p less than 0.005) and showed a significantly higher incidence of both carpal tunnel syndrome (p less than 0.0005) and shoulder pain (p less than 0.005). Our findings confirm the high incidence and clinical importance of dialysis arthropathy in long-term hemodialysis patients and the value of diagnostic imaging in screening such patients for those lesions.

Adult↗
PubMed1991

[Diagnostic imaging for the study of popliteal masses in dialyzed patients].

A new type of amyloidosis, secondary to the massive deposition of beta 2-microglobulin, has been identified which is peculiar to long-term (greater than or equal to 5 years) hemodialysis. Popliteal masses have recently been described as a possible manifestation of this type of amyloidosis. We report the results of a clinical-radiologic study of the popliteal region in 28 patients (14 males, 14 females; age 52.9 +/- 12.6 years) undergoing chronic hemodialysis for 60-212 months (mean 127 +/- 40). We aimed at determining the role of diagnostic imaging (conventional radiography, ultrasonography, Computed Tomography) in this pathologic condition. Clinics detected popliteal masses in 4 patients (bilateral in 1). US allowed 2 more cases to be detected and demonstrated the cystic nature of the lesion. Ultimately, popliteal masses could be demonstrated in 6 (bilateral in 5) of 28 patients (incidence 21.4%). In the 3 patients who were investigated by CT, cysts were seen to communicate with the joint cavity (Baker's cysts). In 1 case, immunocytochemical analysis showed diffuse beta 2-microglobulin positive amyloid deposition within the synovial wall of the surgically removed cyst. All the 6 patients experienced some of the major features of dialysis-related amyloidosis: carpal tunnel syndrome (6 cases), destructive arthropathy (5 cases), carpal and shoulder bone radiolucencies (5 and 4 cases, respectively). These findings, while documenting the high prevalence of popliteal cysts among long-term hemodialysis patients and the strong correlation with dialysis-related amyloidosis, stress the importance of diagnostic imaging in the detection and follow-up of such lesions.

Adolescent↗
PubMed1990

Urinary red blood cell volume analysis in the investigation of haematuria.

The mean cellular volume (MCV) of urinary red blood cells was measured with an autoanalyser in 85 patients with definite causes of haematuria (31 had glomerulonephritis, 54 urological disorders). We found that red blood cells of glomerular origin had a smaller volume than non-glomerular cells (59.4 +/- 10.23 vs 87.35 +/- 11.17 fl; P less than 0.001). If an MCV equal to 70 fl was taken as the cut-off value between glomerular and non-glomerular haematuria, a correct assessment of the site of bleeding was made in 78 (91.7%) of the 85 patients studied. 'Microcytic' haematuria (i.e., MCV less than 70 fl) was present in 34 patients and correlated strongly with the diagnosis of glomerulonephritis (five false positives, specificity 90.7%; two false negatives, sensitivity 93.5%). Conversely, the presence of larger red blood cells in the urine coincided with the diagnosis of urological disorders in 96.1% (49/51) of the cases.

Diagnostic Errors↗
PubMed1990

Elevated serum levels of C-reactive protein in hemodialysis patients.

Serum C-reactive protein (CRP) levels were measured by nephelometry in 30 healthy subjects (controls) and in 99 patients with uncomplicated terminal uremia on conservative therapy (group 1, n = 30) or chronic hemodialysis (group 2, n = 69). Whereas there was no difference between controls and group 1, both the mean concentration of CRP and the incidence of elevated levels were significantly higher in group 2 in comparison with both controls and group 1. Moreover, the degree of increase in these patients was directly correlated with the duration of hemodialysis. The abnormality, therefore, is somehow related to chronic hemodialysis per se. From a practical standpoint, we concluded that this test cannot be recommended as an acute-phase reactant in this clinical setting.

Adolescent↗
PubMed1990

Elevated acute phase reactants in hemodialysis patients.

The incidence of elevated acute phase reactants, measured by nephelometry, was examined in 69 otherwise uncomplicated hemodialysis patients in comparison with 30 healthy subjects. Increased C-reactive protein was found in 40.6% of the patients (p less than 0.001 vs controls) and the degree of increase was correlated with the duration of hemodialysis. Haptoglobin was increased in 33.3% (p less than 0.01 vs controls). High levels of alpha-1-acid glycoprotein and alpha-1-proteinase inhibitor were present in 15.9% and 2.9%, respectively; these frequencies were not significantly different from controls. No differences between pre- and postdialysis values were observed. It is concluded that, unlike C-reactive protein, both alpha-1-acid glycoprotein and alpha-1-proteinase inhibitor maintain an excellent specificity in hemodialysis patients. Vice versa, haptoglobin may be unreliable as an acute phase reactant in these patients because of the unacceptably high false-positive rate.

Acute-Phase Proteins↗
PubMed1990

Immune response to a recombinant hepatitis B vaccine in hemodialysis patients.

A 20-microgram dose of a recombinant hepatitis B vaccine was given at 0, 1, 2 and 6 months to 24 hemodialysis patients. From month 7 (i.e., 1 month after the fourth injection), 58.3% (14/24) of the patients had developed protective levels of antibodies against hepatitis B surface antigen (anti-HBs). In patients responding to vaccination, the fourth injection led to an abrupt rise of the anti-HBs titres which reached their maximum 2 months later, that is, in month 8. At that time, the geometric mean titre of anti-HBs was 145.79 mlU/ml. Eighteen months after the start of vaccination, 50% (12/24) of the patients were maintaining protective levels of anti-HBs antibodies. It is noteworthy that these results could be obtained with a considerably lower dosage than previously recommended.

Female↗
PubMed1990

[Osteo-articular amyloidosis caused by dialysis. Clinical and radiologic aspects].

Twenty-nine patients who had received chronic hemodialysis for more than 5 years provided the material for the present study. In 12 of them (41%) there were radiological findings of dialysis related amyloidosis, mainly destructive spondyloarthropathy of the cervical spine (n = 11) and geodes of the shoulder (n = 5). When compared with negative patients, these patients were significantly older (p less than 0.001 and had been dialyzed for longer periods of time (p less than 0.01). Moreover, in such patients there was an higher incidence of carpal tunnel syndrome (p less than 0.025) and shoulder pain (p less than 0.001). Our results confirm that osteoarticular amyloidosis is a frequent long-term complication of chronic hemodialysis and underline the correlation between clinical and radiological findings.

Adult↗
PubMed1990

[Significance of serum levels of beta-2-microglobulin in dialysis patients].

beta 2M has been shown to be a major constituent of the amyloid deposits developing in uremic patients undergoing long-term hemodialysis. In this study, serum levels of beta 2M were determined in 67 hemodialysis patients and a mean +/- SD concentration of 57.8 +/- 18.5 mg/L was obtained. There was no difference in the concentration of the substance between the patients with evidence of dialysis-related amyloidosis and those without it. Moreover, no correlation between beta 2M levels and duration of hemodialysis was found. Interestingly, the patients with residual diuresis had a significantly lower mean beta 2M concentration than the anuric patients (35.0 +/- 13.1 vs 62.8 +/- 15.8 mg/L, p less than 0.001). Not surprisingly, a significant decrease in the predialysis serum concentration of the substance was obtained after changing treatment from cuprophan hemodialysis to hemodialysis with high-permeable membranes (delta beta 2M = -16.1 +/- 14.4 mg/L at month 6, p less than 0.01). These results suggest the possible long-term use of these membranes to reduce risk of dialysis-related amyloidosis.

Adult↗
PubMed1989

Red blood cell volume distribution width (RDW) in uraemic patients on chronic haemodialysis.

Red blood cell volume distribution width (RDW) was obtained with the Coulter counter in 60 haemodialysis patients and 55 normal individuals. RDW tended to be higher in the former and the degree of increase was to some extent correlated with the underlying nephropathy. Although RDW failed to correlate with conventional tests of iron status, it was observed that iron administration could produce a decrease toward normal in RDW and a parallel increase in haemoglobin when the initial RDW was increased. In contrast, the response to iron was negligible in the patients with normal RDW basally. It was concluded that high RDW is an acceptable indicator of iron deficiency in haemodialysis patients.

Adult↗