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Biomedical subjects

E Vitaliano

Publications and source records attributed to E Vitaliano.

At least 19 recordsLinked to original sources
PubMed2000

Nephrotic syndrome and plasmapheresis.

We studied 15 patients suffering from nephrotic syndrome (NS) in bioptically-accertained primary and secondary glomerulopathies responding poorly to the common pharmacological treatment. They were monitored for one year by assessing their immunological and kidney functionality parameters, especially proteinuria. The patients underwent 3 apheretic sittings using the cascade double-filtration technique. After the third apheretic sitting the patients received metilprednisolone 300 mg/m2. This therapy was repeated every month for 6 months. At the end of the apheretic cycle it was shown that all patients had responded well to the therapy with a dramatic decrease in proteinuria, maintenance and/or recuperation of kidney functionality and improvement of lipidic asset; these data remained unchanged over time. Considering our preliminary results, we believe that therapeutic apheresis has a precise function in refractory nephrotic syndrome and, in particular, we propose the use of the cascade double-filtration technique.

Adult↗
PubMed1997

[Efficacy of recombinant erythropoietin on the quality of life in patients over 60 years of age undergoing hemodialysis].

We followed for a period of six months, 54 patients of over 60 years old, submitted to hemodialitic treatment. We gave human recombinant erythropoietin, average dosage 50 UI/Kg subcutaneously on alternative days, folic acid and iron supplements together with a proteic supply of 1.2 g/Kg/die (35 Kcal/Kg). The medullary response has been monitored with hematochemical tests; blood pressure and nutritional conditions have been evaluated. Furthermore, the patients were given a questionnaire to evaluate their quality of life. At the end of the follow up, 50 patients responded positively to therapy. These patients showed an increase of RBC (from 2,789,780 +/- 259,310 to 3,313,110 +/- 472,780 p < 0.001) of HCT (from 21.86% +/- 2.16% to 27.18 +/- 2.74% p < 0.0001) and of Hb (from 7.72 +/- 1.12 g/dl to 9.28 +/- 0.98 g/dl p < 0.006). Total protein and albumin increased too. Furthermore they showed a progressive increase of "performance status". Our results confirm efficacy of erythropoietin in the treatment of anemia in elderly hemodialized patients.

Age Factors↗
PubMed1997

[Holter monitoring of the arterial pressure in the follow up of a group of aged patients with chronic uremia].

The cardiovascular complication represents the principal effect of death in patients uraemics cronics. The hypertension is one of most cause; for this, the control of hypertension is one important objective in this patients. The introduction of dynamic monitoring permit to estimate the adeguatesse of hypertension control or the appearance of extradialitic hypotension. The dynamic monitoring permit to value the difference in two groups, young and elderly and to conform the hypertension therapy.

Adult↗
PubMed1996

Haemorheological changes in mixed cryoglobulinaemia during apheresis treatment.

Thirty-four patients affected by mixed cryoglobulinaemia have been submitted to treatment by apheresis (plasma exchange or double cascade filtration). The authors have monitored clinical, laboratory and, above all, haemorheological changes following therapy. The final results have shown mainly a reduction of plasma viscosity and consequently an improvement of the haemorheology of the affected organs. In conclusion, apheresis may be considered a successful therapy in patients with severe renal or neurological diseases due to mixed cryoglobulinaemia.

Blood Viscosity↗
PubMed1993

Biocompatibility in hemapheresis: new materials.

The development of new technologies implying the use of semidialytic synthetic membranes in therapeutic apheresis, lays stress also on the problem of biocompatibility. The first alterations of plasma proteins and of the immune system are observable 15 minutes after the beginning of the apheretic session. This may suggest that the acute clinical reactions observed during apheresis are related to biocompatibility. However, the first chronic side effects, comparable to those observed in hemodialysis, do not occur before 10-20 sessions. It is known, in fact, that even when inactive materials, such as the last generation membrane, are used, plasma exchange affects the immune system and may determine plasma protein alterations (protein film, erythrocytic damage, ADP release, beginning of the coagulation process, complement consumption). The whole system or the type of membrane, the involucre, the potting glue and the lines affect the interactions. The contact of blood with a foreign surface initiates a number of local reaction, with subsequent reactivity of the organism. The activation of the complement system, coagulative system, fibrinolytic system and callicrein-kinin system is therefore responsible for the cell functional modifications. It is necessary to underline the role of the membrane surface used, in that the activation of the complement system, of the gathering of platelets and of the cell activity modification all increase with the increase in surface. Biocompatibility may be affected not only by the membranes, but also by the substitution fluids and by the anticoagulant used.

Biocompatible Materials↗
PubMed1991

[Therapy of hypercholesterolemia and hypertriglyceridemia. Comparison of hypolipemic effects of lovastatin and gemfibrozil].

The authors report the results of a comparative study of the effects of lovastatin and gemfibrozil on plasma cholesterol. Both drugs inhibit the enzyme systems responsible for cholesterol synthesis at the initial stages. The trial was conducted in 40 patients with nonfamilial hypercholesterolemia of whom 20 were treated with lovastatin and 20 with gemfibrozil. Throughout the trial, subjects took a dietary regime of about 1500 cal. Thirty days' before the start of the trial, patients received a placebo daily. Before and after the placebo period and at the end of 30 days treatment with either drug, cholesterol, esterified cholesterol, VLDL, LDL, and HDL cholesterol, apolipoprotein B, phospholipid, triglyceride and free fatty acid blood levels were tested, as well as the level of fatty acid saturation (iodine number), and the activities of lipase and plasma heparin. The results obtained showed both drugs to induce significant reductions of total, VLDL- and LDL-cholesterol and apolipoprotein B, and a relative increase in HDL-cholesterol. Triglyceride blood level was more markedly reduced in patients treated with gemfibrozil compared to those treated with lovastatin, a difference accounted for by the different levels at which the two drugs interfere with the enzymes of the initial stages of cholesterol synthesis. Plasma free fatty acids rose more markedly under gemfibrozil while plasma lipase and heparin activity did not show any appreciable changes under either drugs. The authors conclude by pointing out that the use of these drugs should be decided according to the type of metabolic disorder to be corrected.

Aged↗
PubMed1990

[Comparison of the lowering effect on blood cholesterol of clofibrate and simvastatin].

The authors report the results obtained in a comparative study of effects of clofibrate and simvastatin. The investigation was carried out on 44 patients with type IIB hypercholesterolemia subdivided into two groups. Throughout the study, patients observed a diet of about 1500 Kcal daily. Thirty days before starting drug treatment, all patients were given a placebo daily, either of the two drugs being administered during the subsequent 30 days. Plasma cholesterol level was examined before starting placebo and before drug treatment and every five days throughout drug treatment. The results obtained showed that both drugs reduced cholesterol plasma level significantly but the reduction obtained with simvastatin was greater than that obtained with clofibrate. The specificity of the use of these drugs in the management of hypercholesterolemia is stressed.

Aged↗
PubMed1990

[Therapy of hypercholesterolemia and hypertriglyceridemia. Comparison of the lipid-lowering effect of simvastatin and tiadenol].

A comparative trial was carried out on the effect on lipid metabolism of two drugs which inhibit the enzyme systems involved in cholesterol synthesis: tiadenol and simvastatin. The trial was performed in 40 patients with non familial and non secondary hypercholesterolemia. Subjects were divided into two groups of 20 patients each, one to be treated with tiadenol, the other with simvastatin. During the study period all patients followed a dietary regime of about 1500 cal daily. Thirty days before the trial, patients were given a placebo daily, and this was followed by thirty days with the drugs studied. Prior to the placebo period and at the end of the experimental period, blood was drawn for the assessment of total cholesterol, esterified cholesterol, VLDL-, LDL- and HDL-cholesterol, apolipoprotein B, phospholipids, and triglycerides. Both drugs were found to induce significant reductions of total cholesterol, VLDL, and LDL, a relative increase of HDL, and reduction of apolipoprotein B. Triglyceride blood level was markedly reduced in tiadenol-treated subjects, and to a lesser extent also in simvastatin-treated ones. This difference is attributed to the different levels at which the drugs interfere with the early steps of cholesterol synthesis. The authors conclude by pointing out that the two drugs should be used selectively according to the type of metabolic disorder prevalent in the individual patient.

Aged↗
PubMed1989

[Preliminary results of an open study on the effects of DEAE-dextran on various lipid metabolism parameters in dyslipidemic subjects].

The authors report the results of a study of 1963 patients treated with daily doses of 2 g DEAE-dextran. This was an open trial intended to evaluate the evolution of several biohumoral parameters under treatment for dyslipidemias. Statistically significant results were obtained for cholesterol blood level, triglycerides and body weight, as well as a favorable trend for HDL-cholesterol. Side effects or untoward reactions to DEAE-dextran were not observed.

Aged↗
PubMedDate not supplied

Plasma cortisol and testosterone in hypercholesterolaemia treated with clofibrate and lovastatin.

Plasma testosterone and cortisol concentrations were measured in 32 familial heterozygous hypercholesterolaemic subjects, aged 40-45 years. The subjects were divided into two groups of 16, each containing eight men and eight women. The women had normal menstrual cycles. After a period on placebo, one group of patients was given 40 mg/day lovastatin and the other was given 1500 mg/day clofibrate. Both drugs significantly reduced the plasma cholesterol concentration, however, unlike clofibrate, lovastatin did not decrease plasma levels of testosterone and cortisol. The response to stimulation by adrenocorticotrophic hormone of plasma cortisol and urinary 17-hydroxy levels was significantly reduced by treatment with clofibrate, but unchanged by lovastatin. The different effects produced by the two drugs probably reflect different mechanisms and sites of action.

Adult↗
PubMedDate not supplied

[Plasmapheresis combined with pharmacology in the treatment of lupus nephritis: a new therapeutic protocol].

Systemic Lupus Erythematosus (SLE) is a pathology of unknown cause, characterized by tissue and cellular damage, secondary to production of autoantibodies and to deposition of immunocomplexes. Lupus nephritis is one of the most common complications of SLE. Our purpose is to propose a therapeutic protocol for patients suffering from Lupus nephritis. This consists of Plasmapheresis associated with pharmacological therapy so that dosage of immunosuppressors can be reduced and consequently also the side effects of the pharmacological therapy.

Adolescent↗
PubMedDate not supplied

[Pharmacokinetic principles and drug-dosing adjustments during continuous renal replacement therapies (CRRT)].

In the critically ill, acute renal failure (ARF) and "Multiple Organ Dysfunction Syndrome" (MODS) can be associated with significant modifications of many pharmacokinetic parameters, such as protein binding, volume of distribution and total body clearance. The start of renal replacement therapy (RRT) represents an additional variable to take in consideration for drug-dosing adjustments. Drugs significantly eliminated by the kidney are likely to be removed during RRT and a supplemental dose or further dosing adjustments are required if extracorporeal clearance is more than 25-30% of total body clearance. The impact of RRT on plasma drug concentrations can be substantially different in relation to the type of treatment (diffusive, convective or both), membrane characteristics (low-flux or high-flux), filter surface area and prescribed dialysis dose. The molecular weight cut-offs of high-flux membrane are much higher than the molecular weight of most drugs. Therefore, molecular size will not be a limitation for the removal of the unbound fraction of the drugs most commonly used in the critically ill undergoing continuous renal replacement therapy (CRRT). However, diffusive clearance could be significantly lower than convective clearance for drugs in the middle molecular weight range. In any case, the extracorporeal clearances report-ed with the use of high-volume CRRT (>50-60 L/2 h) are often surprisingly elevated and can lead to drug underdosing in clinical conditions where adequate antibiotic treatment is essential.

Acute Kidney Injury↗