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Biomedical subjects

F Bonello

Publications and source records attributed to F Bonello.

At least 19 recordsLinked to original sources
PubMed2001

Improved phagocyte response by co-amoxiclav in renal transplant recipients.

BACKGROUND: Infectious diseases are a major source of morbidity and mortality for immunosuppressed transplant recipients and the antimicrobial chemotherapy can be often less effective in these individuals, because the contribution of underlying host defenses is absent. METHODS: The influence of co-amoxiclav on the functions of polymorphonuclear granulocytes (PMNs) from renal transplant recipients were investigated. RESULTS: PMNs from renal transplant recipients showed a diminished phagocytic activity with reduced phagocytosis and bactericidal activity against intracellular Klebsiella pneumoniae, compared to that seen with PMNs from healthy subjects. Co-amoxiclav significantly elicited the functions of PMNs from uremic patients, resulting in an increased percentage of ingested klebsiellae and in a higher bactericidal effect (98-99%), compared with the drug-free control system. When PMNs were collected from renal transplant recipients treated with co-amoxiclav a significant high increase in both phagocytosis and killing activity were detected, showing the co-amoxiclav capability of "restoring" even in vivo the depressed primary functions of PMNs. CONCLUSIONS: The interesting beneficial properties of co-amoxiclav, which result in restoring the phagocyte-dependent response in renal transplant patients both in vitro and in vivo, may make this drug more suitable for the treatment of infections in patients with defects of phagocyte functions.

Amoxicillin-Potassium Clavulanate Combination↗
PubMed2000

Outcome of dialysis patients submitted to coronary revascularization.

Cardiovascular disease accounts for almost half of the total mortality in patients with end stage renal disease (ESRD). It has recently been debated whether coronary revascularization has the same rate of risks and successes in this cohort of patients compared to patients without renal disease. Since 1991, 17 dialysis patients were submitted to coronary revascularization in our center. Seven patients were following peritoneal, 10 hemodialytic treatment. Four patients were submitted to percutaneous transluminal coronary angioplasty (PTCA) and 13 to surgical revascularization (CABG). In 2 patients the coronary lesion was unique, in the others stenosis of multiple vessels were found. Six patients were diabetic. The mean age at the onset of the coronary artery disease (CAD) was 57.17 +/- 11.6 years. The mean time elapsed from the onset of the CAD and the performance of the PTCA or CABG was 30.1 +/- 35.4 months. The mean time from beginning of dialysis treatment to revascularization was 48.2 +/- 39.6 months. Mean hemoglobin values were 9.7 +/- 1 g/dL, mean phosphorus values were 5.2 +/- 8.7 mg/dL, mean cholesterol values were 211 +/- 49.5 mg/dL. The procedure was technically successful in all patients. Mean survival was 25.09 +/- 28.12 months. Twelve patients died, 5 of whom within one month. Survival at one month was 70.5%, at 6 months 58.8%, at one year 52.9%, at 2 years 47%. There was neither significant difference patients submitted to PTCA and those submitted to CABG, nor between diabetic and non-diabetic patients. In conclusion, coronary revascularization in our experience is a high risk procedure in dialysis patients. The reasons for this could be the severe general conditions of these patients affected with diffuse vasculopathy and the long time elapsed since the onset of the ischemic cardiopathy. Thus, our results could suggest the opportunity of performing earlier screening of coronary situation and revascularization treatment in CAD dialysis patients.

Age of Onset↗
PubMed1995

Two years of experience with a new device system: a multicenter study.

Peritonitis is a crucial complication of peritoneal dialysis. Over the last few years, new device systems have been developed to reduce episodes of peritonitis caused by exogenous contamination. Remarkable improvement has been obtained by modifying the original connection between the catheter and the bag with the introduction of the Y-set. The aims of this study were to test the reliability and simple use of a double-bag system without disinfectant in-line (Gemini, Gambro) and to evaluate the incidence of peritonitis in a 2-year period of follow-up. In a group of 167 patients, enrolled in 14 dialysis units in Italy, with a follow-up of 2433 patient-months, we observed 82 episodes of peritonitis in 52 patients, with a cumulative incidence of 1 episode every 29.7 patient-months. At 12 months the percentage of patients peritonitis-free was 69.7%, and at 24 months it was 62.8%. The training to complete the bag exchange, assessed by patient and nursing staff, was defined as "easy" in 61% of the cases and "difficult" in only 12% of the cases. The percentage of patients requiring a partner was 23%. For patients this device system presents easy handling in terms of the bag exchange, and it may prevent peritonitis.

Adult↗
PubMed1994

Beta-thalassemia syndromes and pregnancy.

The literature relating to homozygous beta-thalassemia and the problems these patients have during their pregnancy is reviewed and another case report of a twin pregnancy in a homozygous beta-thalassemia individual is included. The majority of cases described refer to the intermedia clinical form of the hematological problem because patients with thalassemia major generally have poor sexual development. Although the reported cases had a greater frequency of delayed development, only one woman suffered from infertility and required ovulation induction agents. The thalassemia pregnant mother faces deleterious consequences resulting from chronic anemia and in nonsplenectomized patients there remains the risk of the onset of a hypersplenic crisis. The problems of splenectomized patients during pregnancy is also discussed. The chronic anemia of thalassemic patients predisposes to a poor fetal outcome with greater fetal loss, preterm labor, and intrauterine growth retardation.

Adult↗
PubMed1994

["Prophylactic" video-laparoscopic cholecystectomy].

The authors examine the prophylaxis of infections caused by cholelithiasis in kidney and heart transplant candidates as a new indication for videolaparoscopic cholecystectomy (VLC). The study included 6 patients in dialysis for chronic renal insufficiency and one patient suffering from cyanogenic congenital cardiopathy with asymptomatic gallbladder calculosis. The results obtained show that there are no substantial differences compared to patients without associated pathologies and justifies the inclusion of "prophylactic" VLC in preparatory treatment protocols for kidney and heart transplant in patients suffering from cholelithiasis. The authors emphasise the necessary technical measures to prevent hemorrhage, intraoperative loss of CO2 and postoperative laparoceles.

Adult↗
PubMed1994

[Surgical interventions in dialysis patients in Piedmont: data from the Regional Registry. Working Group of the Piedmont Registry of Dialysis and Transplantation].

In this work surgical events in a large population of chronic dialysis patients are analysed. Data are obtained from the Regional (Piedmont) Registry of Dialysis and Transplantation (RPDT), that has collected information since 1981 about all chronic dialysis patients in the Region. Since 1984, causes of admission to-hospital are registered. Surgical causes of hospitalization, for purposes not related to uremia, were 538 (20% of all surgical admissions). In patients younger than 65 years, these hospitalizations account for about 6% of the cases, whereas in patients older than 65 they are less than 5%. As expected, a higher number of surgical operations is observed in diabetics, while on the contrary the lowest is performed in nephroangiosclerosis patients. Cardiovascular and bowel diseases represent almost 50% of all surgical needs. Postoperative mortality was 5.8% within 45 days from admission. Cardiac and infectious diseases and cachexia represent the more frequent causes of death. In 27 out of 28 cases at least one high risk condition was present.

Aged↗
PubMed1994

[Choice of dialysis methods as initial substitutive treatment: trends in the last 10 years].

The authors report data from the Regional Piedmontese Registry about the evolution of choices concerning dialytic therapy in the 20 regional dialysis Units during the years 1981-1990. They confirm a scale-down of acetate dialysis that is replaced with bicarbonate dialysis; besides a limited use of convective dialysis whereas peritoneal dialysis is steady. At the same time they remark an increase in admittance to dialysis and older patients.

Adult↗
PubMed1994

[The value of albumin and cholesterol blood levels as indicators of the risk of death in dialysis. Working Group of the Piedmont Registry of Dialysis and Transplantation].

In recent years, the availability of large epidemiological series allowed identification of biochemical outcome markers in the dialysis population. Interest towards albumin and cholesterol levels is motivated by their easy availability and by the presence of a strong short-term effect on mortality and morbidity. The aim of the study was an analysis of the relationship between albumin and cholesterol levels at start of dialysis and mortality (gross mortality and Kaplan Meier survival curves). Data were obtained from the Piedmont Regional Registry of Dialysis and Transplantation (Northern Italy Region, about 4,400,000 inhab, 20 Dialysis Centers, open acceptance since mid '70, yearly information on 100% of patients) in the period 1981-1990 (4734 patients on file). Only non diabetic patients with follow-up > = 1 month, who started treatment in the Region, were selected. Patients with renal function recovery were excluded. Albumin levels were dichotomized at 3.5 g/dl. Cholesterol was stratified into 3 levels (< 150, 150-250, > or = 300 mg/dl). The choice of dividing the study into 2 periods (1980-1985 vs 1986-1990) is due to the fact that 1984 has been the year of switch from acetate to bicarbonate dialysis. Prevalence of albumin and cholesterol under the normal range (22% and 15%) is low and rises with age and presence of high risk conditions. A a good correlation with the risk of death of these biochemical markers (stronger for albumin at least in the short term) was observed. No correlations are found with risk of death and elevated cholesterol levels (low number of cases).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

[Automated peritoneal dialysis (APD). Experience in 42 patients].

Automated peritoneal dialysis (APD) is currently considered as one of the most attractive home treatments for uremic patients. However, relevant costs and the presence of a dialysis machine prevent a wider diffusion of this technique. In this work we discuss the results obtained in 42 patients (12 females, 30 males) treated by two dialysis units of the Piedmont Region. Patients' characteristics. Eighty-three percent of the females and 66.5% of the males are under 65 years of age; glomerulo-nephritis and nephroangiosclerosis account for the most frequent renal diseases (28.5 each); a high risk condition is recorded in 52.5% of cases. Twenty-two patients were transferred to APD from CAPD (patient's request in 59% of cases, clinical problems in the remaining). RESULTS. Forty-five percent of cases are working full or part-time, 12% are not caring for self. Peritonitis rate accounts for 1 episode every 42 patient-months. Biochemical control is satisfactorily achieved (mean values: urea 137.8 mg/dl, creatinine 11 mg/dl, calcium 10.2 mg/dl, phosphate 5.7 mg/dl, albumin 4.3 g/dl, cholesterol 234 mg/dl, triglycerides 195 mg/dl). Technical assistance was requested on average once every 16 months of treatment. CONCLUSION. Negative drawbacks of APD, mainly related to elevated costs and technical complexity, are fully counterbalanced by satisfactory social and clinical rehabilitation, wider indications to peritoneal dialysis with respect to CAPD, lower rates of peritonitis and limited technical needs.

Adult↗
PubMed1993

Diabetic patients on dialysis: a changing picture.

Prevalence of diabetic patients on dialysis is often considered a marker of overall acceptance rate for dialysis; however, even when acceptance policy is open, incidence of diabetic patients varies widely. Epidemiological differences of diabetes incidence all over the world partly explain the discrepancies. Incidence of diabetic patients accepted for dialysis (1981 to 82: 6 p.m.p.; 1989 to 90: 11.5 p.m.p.) differs according to age and sex in the setting analyzed (Piedmont, Northern Italian region, about 4,400,000 inhabitants, 20 dialysis centers, open acceptance since the mid-70s, yearly information on 100% of patients, gathered by a Dialysis and Transplantation Registry). Patterns changed remarkably during the 10 years considered (1981 to 90). Incidence was higher in males (10.4 p.m.p. in the period 1981 to 90), with a peak at ages 60 to 69. Incidence remained relatively stable in the younger patients, but increased in the elderly, mainly in males, rising from 6.23 in 1981 to 82 to 12.88 p.m.p. in 1989 to 90 (males, all ages). In conclusion, the demographic characteristics of diabetic patients with ESRD accepted for dialysis is changing. The stability of incidence of younger patients reassures about the open acceptance policy, at least in these ages. The increase in the elderly probably reflects the longer lifespan of diabetic patients in the overall population. The possibility of a hidden preselection must be further assessed. Future provisions of dialysis needs must take into account the trend towards an increase of this high risk, elderly population.

Adult↗
PubMed1993

Death in conditions of cachexia: the price for the dialysis treatment of the elderly?

Death in conditions of cachexia is increasing in potential dialysis patients, as treated cohorts are aging, the mean age of new patients increased and access to treatment is unlimited. The present study analyzes the clinical features of 417 deaths in conditions of cachexia recorded in 1981 to 1990 in the Dialysis and Transplantation Registry of a northern Italian region, Piedmont (about 4,400,000 inhabitants, 20 dialysis centers; 4,734 patients on file at December 31, 1990; yearly information on 100% of the cases). Death in conditions of cachexia increased from 105 cases in the first four years taken into account (1981 to 1984), to 107 in the last two years (1989 to 1990). Prevalence is higher in the elderly (85% of the death over age 60). Most patients (90.5%) were at high clinical risk. To assess whether the frequency of this diagnosis reflected the wide acceptance of elderly patients for dialysis and was a marked of vascular disease, a specific inquiry was conducted about 107 cachectic deaths recorded from 1989 to 1990: 82.5% of the patients had diffused vascular disease, 11.5% were already cachectic when dialysis was initiated, and 66% were in cachexia at least six months before death. Since mean age of patients dying in condition of cachexia increased from 68.8 in the period of 1981 to 1984 to 70.3 years in 1989 to 1990, and mean time on dialysis from 2.8 years in 1981 to 1984 to 70.3 years in 1989 to 1990, the higher prevalence is not likely to be due to lack of care of elderly patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

In vitro and in vivo efficacy of a new connector device for continuous ambulatory peritoneal dialysis.

The purpose of this study was to evaluate the in vitro and in vivo efficacy of a new connection system for continuous ambulatory peritoneal dialysis (CAPD), called the T-set. With this system the patient wears a 27-cm extension line filled with Amuchina during the dwell time; the bag is made of a fill container linked to a drainage tube with a Y-shaped set. For bag exchange, only one connection is needed and this is subsequently flushed with the entire drainage volume. The in vitro efficacy of the system was tested with 20 sets filled with 10 mL of Amuchina and inoculated in the distal lumen with 2.1 x 10(3) colony-forming units (cfu) of S. aureus. After an incubation of 4-6 hours at 35-37 degrees C, three dialysate samples per set were collected, respectively, at the beginning of drainage and filling. All 120 samples were negative, whereas two control sets, filled with a phosphate-buffered saline, had positive drainage samples, and at least one positive infusion sample, indicating the efficacy of Amuchina in sterilizing the system under conditions simulating touch contamination. To evaluate the in vivo efficacy, safety, and acceptability of the T-system, a prospective randomized controlled trial was performed in seven centers: a control group (CG) of 56 patients (follow-up: 952.3 months, mean +/- SD: 17.0 +/- 7.8) was treated with a long branch (21 patients) or short branch (35 patients) Y-set and a test group (TG) of 66 patients (follow-up:898.1 months, mean +/- SD: 13.6 +/- 7.8) with the T-set.(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluation Studies as Topic↗
PubMed1990

Erythrocyte Na-stimulated Mg transport in uremic patients undergoing CAPD.

A derangement of magnesium homeostasis with hypermagnesemia and increased intraerythrocyte Mg content [Mgi] has been described in uremic patients, and could play a pathogenetic role in both alterations of bone metabolism and vascular reactivity, observed in these patients. Recently Féray and Garay described in human erythrocytes a transport system which catalyzes outward Mg movements in the presence of external Na. These fluxes may be responsible for maintaining and regulating a low [Mgi]. The aim of this study was to evaluate in 16 normal subjects and 14 uremic patients undergoing CAPD: [Mgi] and rate of Na-dependent and Na-independent Mg efflux in Mg-loaded erythrocytes, in order to maximally stimulate Mg efflux. Mean plasma and intraerythrocyte Mg concentrations were significantly higher in CAPD than in normal subjects (1.09 +/- 0.20 vs 0.86 +/- 0.004 mmol/l, p less than 0.001 and 2.57 +/- 0.38 vs 1.96 +/- 0.18 mmol/l RBC, p less than 0.001). After an in-vitro Mg load, the intraerythrocyte Mg concentration and Na-independent Mg efflux were similar in both groups (17.5 +/- 1.4 vs 18.2 +/- 4.1 mmol/l RBC and 152 +/- 20 vs 126 +/- 19 mumol/l RBC/h). However, the Vmax of erythrocyte Na-stimulated Mg efflux was significantly higher in CAPD patients than in normal subjects (357 +/- 48 vs 229 +/- 88 mumol/l RBC/h, p less than 0.02). [Mgi] and the rate of Na-dependent Mg efflux were inversely related in CAPD patients (r = -0.76; p less than 0.002). These results indicate that uremic CAPD patients have a [Mgi] and Vmax of erythrocyte Na-dependent Mg efflux higher than normal subjects; this could reflect a compensatory, although insufficient, mechanism against high levels of intraerythrocyte Mg concentration, as suggested by the correlation between [Mgi] and the rate of Na-dependent Mg efflux.

Biological Transport↗
PubMed1989

CAPD in a large population: a 7-year experience.

In this report we evaluate the results obtained with CAPD in uremic patients in Piedmont, a Northern Italian region (4.4 million inhabitants) during the last 7 years. Data are gathered from the computerized records of the regional dialysis and transplantation registry, which collects information on 3,567 pts, 2,243 of which entered since Jan. 1981 and 1,808 alive at Dec. 1987. Among these, 193 (11%) were on CAPD, a figure almost constant in the last 7 years. However CAPD diffusion is not uniform among the 20 centers of the region, ranging from 0 to 49.5% of the patients on dialysis. CAPD is particularly employed in the elderly (47.5% of the patients being older than 60 years and 19.5% over 70). This treatment was the first choice in 16% of the patients admitted to dialysis between 1981-87; this figure reaches 33% for the diabetics. High drop out rates still represent a major problem, in a 6 year follow up 66% of the patients being transferred to another dialysis treatment. Peritonitis is the main cause of drop out (22%), while loss of peritoneal membrane efficiency accounts for 7%, patient's choice 14%, catheter complications 14%, inability to cope 8%, clinical problems 20% and other reasons 15%. Drop out rate is not influenced by the presence of high risk condition or age. Survival curves show no significant difference for CAPD in comparison to hemodialysis in all the age groups considered. This epidemiological survey, based on a global 522 pts experience extended over a 7 year period, indicates that CAPD is a competitive mode of treatment in chronic uremia.

Acetates↗