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Biomedical subjects

D Marian

Publications and source records attributed to D Marian.

11 recordsLinked to original sources
PubMedDate not supplied

[Prognosis and treatment of membranous glomerulonephritis-a 5-year prospective study].

UNLABELLED: The aims of the study were to describe the clinical, pathological and biological features of membranous GN and to prospectively evaluate the relationships between individual negative prognostic factors--type of therapy and outcome. Between 1993-1998, 13/150 (8.7%) consecutive patients with renal biopsy had membranous GN (M = 62%, age = 42.5 +/- 14.5 years). Main (major) findings in these patients were: asymptomatic proteinuria--23.1%, heavy proteinuria (> 10 g/day)--33.3%, microscopic hematuria--53.8%, increased plasma creatinine levels--33.3%, hypertension--23.1% cases. 60% of the patients with nephrotic proteinuria had an underlying cause (infection, malignancy, immune-mediated systemic diseases). 40% of the patients with nephrotic proteinuria had 0 or less than 2 negative prognostic factors (without any of the recognized severe morphological changes). The following differentiated treatment protocols were applied: no treatment for asymptomatic proteinuria (group A), i.v. methyl-prednisolone boluses + prednisone 1 mg/kgc/day 3 months for those patients with few negative prognostic factors (group B), and steroids (as above) + cyclophosphamide (2 mg/kgc/day 3 months) or the Ponticelli regime in patients with important risk factors (group C). Outcome after a median follow-up period of 24 months was: complete remission in all cases from groups A + B (with only one exception were the underlying cause was breast malignancy); in group C in 75% of the subjects a complete or partial remission (proteinuria < 1 g/day) was obtained. Only one case progressed to chronic renal failure. There were no secondary effects from corticoids or immunosuppressive therapy. CONCLUSIONS: In membranous GN treatment should be tailored to the presence and type of negative prognostic factors. Even in high-risk patients combined steroids and immunosuppressive therapy determines a favorable outcome in 75% of the cases, without severe adverse effects.

Adult↗
PubMedDate not supplied

[Multivisceral operations for carcinoma of the upper stomach and cardia].

In this study are noted technical problems regarding "en bloc" multiple organ resections and the anatomic and functional reconstruction for carcinoma of the upper stomach and cardia. From 1997 to 2002, a total of 264 patients with cancers of the stomach were operated in the service. 75 patients presented cancers localized at the proximal stomach and cardia (97.33% adenocc.). The rate of resectability was 27.77% (27 pt.). Types of operations in this series were: standard esophagogastrectomy in 7 patients; total gastrectomy with regional lymphadenectomy in 9 patients; 11 patients underwent "en bloc" multiple organ resection, with the removal of the stomach, partial or total esophagectomy and, occasionally, ablation of the spleen, pancreas, left hepatectomy, resection of the diaphragm and an extensive lymphadenectomy. Surgical mortality for the complex multivisceral resections was noted in 3 patients (8.88%). The global 5 years survival in the service is poor: 15.9%.

Adolescent↗
PubMedDate not supplied

[The relationships of rapidly progressive glomerulonephritis (RPGN), crescentic glomerulonephritis and vasculitis: the clinical, histopathological and therapeutic considerations].

Rapidly progressive glomerulonephritis (RPGN) is a rare but severe condition, with a particular poor outcome in the absence of aggressive therapy. Our study describes all RPGN consecutive cases treated during the 1994-1995 period, with special interest in revealing negative prognostic features at presentation and the optimum therapeutic strategy. 14 (20% of all ARF for the same period) cases were classified as RPGN. Although rare (30%), extrarenal symptoms were related with a more unfavourable course. Creatinine clearance at presentation was not a reliable prognostic factor in our study. ANCA was found in 86% of our patients (p-ANCA/c-ANCA = 2/1), and therapeutic success was associated with ANCA disappearance. Crescentic glomerulonephritis was seen in 93% of all cases 77% of which were type III, pauciimune, ANCA positive. Vasculitic lesions and fibrous crescents, but not % of glomerular circumference or % of affected glomeruli were also related with a poor prognosis. Only 43% of our RPGN cases survived with a normal renal function. i.v. metil-prednisolone (at presentation, as soon as possible) followed by i.v. cyclophosphamide up to six months was the best therapeutic regimen, with no important side-effects.

Acute Disease↗