PubMed Health⌕ Search

Biomedical subjects

F De Padova

Publications and source records attributed to F De Padova.

10 recordsLinked to original sources
PubMed2004

Routine insertion of permanent peritoneal dialysis catheters in the nephrology ward. The sliding percutaneous technique.

AIM: A prerequisite to the technical success of peritoneal dialysis in its different modifications is a safe, reliable, correctly positioned, and functioning peritoneal catheter. The ideal method for insertion of permanent catheters (PC) remains debatable. The most commonly used technique is an open surgical approach, by minilaparatomy. Others have proposed a blind approach, using either a trocar method or a modified Seldinger technique or an insertion by means of peritoneoscopy. METHODS: We describe our 5-year experience (May 1997 - June 2002) with 68 percutaneous PC insertions in 63 consecutive patients. A modified technique of percutaneous PC insertion was used that here we call sliding percutaneous technique (SPT): 1) a midline incision is made 4 cm below the umbilicus; the peritoneum is punctured using a straight plastic catheter with a stylet. The catheter is pushed caudally towards the left iliac fossa; 2) a straight stiff 90 cm stylet is inserted through the temporary catheter, which is subsequently removed. The stylet has 2 tips, a blunt proximal one, which is pushed through the catheter into the iliac fossa, and the distal one; 3) having the stylet in situ, a double-cuffed curled-end PC is mounted at the distal tip of the stylet starting from the curl; then, the PC is gently slid down along the stylet as a train does along the rail-way. PC failure was defined as mechanical dysfunction, persistent dialysate leak and persistent peritonitis, or exit site/tunnel infection requiring PC removal. Furthermore, PC failure was defined as early, if occurring in the first 30 days after PC placement, or late, if occurring more than 30 days post-operation. Life-table estimates of PC survival were determined by Kaplan-Meier analysis. RESULTS: Early complications: in the 1st month on dialysis, obstruction to dialysate flow was the commonest cause leading to PC failure. The early actuarial survival (AS) was 90%. Late complications: peritonitis was the commonest cause of PC failure. The late AS, i.e. excluding the catheter failures occurring in the 1st month post-operation, was 82% at 3 years. Global AS, i.e. including both early and late PC failures, was excellent (74% at 3 years). CONCLUSIONS: Even though this study is retrospective and does not compare percutaneous with surgical PC placement techniques, it allows us to state that percutaneous PC insertion is a well-tolerated, rapidly performed, side-room procedure that gives excellent results, above all when using SPT.

Aged↗
PubMed2001

Efficacy and safety of haemodialysis treatment with the Hemocontrol biofeedback system: a prospective medium-term study.

BACKGROUND: Hypovolaemia has been implicated as a major causal factor of morbidity during haemodialysis (HD). A model biofeedback control system for intra-HD blood volume (BV) changes modelling has been developed (Hemocontrol), Hospal Italy) to prevent destabilizing hypovolaemia. It is based on an adaptive controller incorporated in a HD machine (Integra), Hospal Italy). The Hemocontrol biofeedback system (HBS) monitors BV contraction during HD with an optical device. HBS modulates BV contraction rates by adjusting the ultrafiltration rate (UFR) and the refilling rate by adjusting dialysate conductivity (DC) in order to obtain the desired pre-determined BV trajectories. METHODS: Nineteen hypotension-prone uraemic patients (seven males, 12 females; mean age 64.5+/-3.0 SEM years; on maintenance HD for 80.5+/-13.2 months) volunteered for the present prospective study that compared the efficacy and safety of bicarbonate HD treatment equipped with HBS, as a whole, with the gold-standard bicarbonate treatment equipped with a constant UFR and DC (BD). The study included three phases: Medium-term studies started with one period of 6 months of BD and always had a follow-up period of HBS treatment ranging from 14 to 30 months (mean 24.0+/-1.6); short-term studies started in September 1999, when all patients went back to BD treatment for a wash-out period of 4 weeks and a short-term study period of a further 3 weeks (phase A). Afterwards, they once again started HBS treatment for a wash-out period of 4 weeks and a short-term study period of a further 3 weeks (phase B). Every patient underwent acute studies during a single HD run, once during phase A and once in phase B. Resistance (R) and reactance (Xc) measurements were obtained utilizing a single-frequency (50 kHz) tetrapolar bioimpedance analysis (BIA). Extracellular fluid volume (ECV) was calculated from R, Xc, and height and body weight measurements using the conventional BIA regression equations. RESULTS: The overall occurrence of symptomatic hypotension and muscle cramps was significantly less in HBS treatment in both medium- and short-term studies. Self-evaluation of intra- and inter-HD symptoms (worst score=0, best score=10) revealed a statistically significant difference, as far as post-HD asthenia was concerned (6.2+/-0.2 in HBS treatment vs 4.3+/-0.1 in BD treatment, P<0.0001). No difference was observed between the two treatments when comparing pre- and post-HD lying blood pressure, heart rate, body weights and body weight changes in medium- and short-term studies. The residual BV%/ Delta ECV% ratio, expression of the vascular refilling, was significantly higher during HBS treatment in acute studies. CONCLUSIONS: HBS treatment is effective in lowering hypovolaemia-associated morbidity compared with BD treatment; this could be related to a greater ECV stability. Furthermore, HBS is a safe treatment in the medium-term because these results are not achieved through potentially harmful changes in blood pressure, body weight, and serum sodium concentration.

Aged↗
PubMed1998

Unilateral thoracoscopic reduction pneumoplasty for asymmetric emphysema.

OBJECTIVE: We prospectively analyzed the surgical and functional results of unilateral thoracoscopic reduction pneumoplasty which we performed by choice in patients with asymmetric emphysema. METHODS: Between October 1995 and June 1997, 119 emphysematous patients were examined and 34 were operated upon. Among these, 14 selected patients with asymmetric distribution of emphysema in the lungs underwent unilateral reduction pneumoplasty (ten right, and four left). There were 13 males and one female, with a mean age of 62 years. Eligibility criteria included bullous and non-bullous end-stage emphysema with severe limitation to daily activity. RESULTS: No patient required conversion to thoracotomy. Mean operative time ranged between 70 and 240 min with a mean of 103 min. There was no postoperative mortality but five patients developed one or more complications: five prolonged air leaks (>7 days); two pulmonary infections; one empyema. No patient required postoperative mechanical ventilation. Median hospital stay was 8 days. At the 3-month follow-up the mean FEV1 increased from 0.8 l to 1.2 l (P < 0.001). Mean FVC increased from 2.6 l to 2.9 l (P < 0.001). The Medical Research Council dyspnea score decreased from a mean of 3.2 to 1.8 (P < 0.001). CONCLUSIONS: Asymmetric distribution is a frequent finding in patients with severe emphysema. Unilateral thoracoscopic reduction pneumoplasty may represent an ideal approach in this selected group of patients.

Aged↗
PubMed1994

Hepatitis B virus infection in chronic uremia: long-term follow-up of a two-step integrated protocol of vaccination.

Active immunization is crucial for eradicating hepatitis B virus infection from dialysis units. A prospective study was performed in 63 consecutive chronic uremic patients, which included the following: (1) the intramuscular (IM) administration of 40 micrograms of a DNA-recombinant vaccine (Engerix-B, Smith Kline & French Laboratories, Milan, Italy) to all chronic uremic patients at 0, 1, 2, and 6 months; (2) the antibody titer determination at the seventh month (chronic uremic patients with a titer > 100 mIU/mL received an IM booster dose of 40 micrograms at 18 months [group A], and those with a titer < 100 mIU/mL received a further IM dose of 40 micrograms at 12 months [group B]); and (3) the intradermal inoculation of 5 micrograms of vaccine every 2 weeks until the protective titer (> or = 10 mIU/mL) was achieved, and then monthly for 6 months, in chronic uremic patients who did not have a protective titer even after 19 months (group C). Thus, 41, 17, and five chronic uremic patients were allocated to groups A, B, and C, respectively. All developed a protective titer: 79.4%, 84.0%, and 87.5% after the fourth, fifth, and sixth IM dose at 7, 13, and 19 months, respectively. Five chronic uremic patients (group C) achieved seroprotection after 3.8 +/- 0.5 (SEM) intradermal inoculations.(ABSTRACT TRUNCATED AT 250 WORDS)

Chronic Disease↗
PubMed1992

A successful two-step integrated protocol of anti-HBV vaccination in chronic uremia.

A prospective study was performed in 40 chronic uremics which included: (1) the intramuscular administration to all patients of 40 micrograms of a DNA-recombinant vaccine (Engerix-B) at 0, 1, 2, 6 months; (2) an intramuscular booster dose of 40 micrograms at 18 months in patients having an anti-HBs titer greater than 100 mIU/ml at the 7th month (group A); (3) a further intramuscular supplementary dose of 40 micrograms at 12 months (besides that at 18 months) in patients developing an antibody titer less than 100 mIU/ml at the 7th months (group B); (4) an intradermal course of 5 micrograms of vaccine every 2 weeks until the protective titer (greater than or equal to 10 mIU/ml) was achieved, and then every month for a total of 6 months in patients who did not develop a protective titer even after 19 months (group C). At the end of the study, all patients had developed a protective titer: 77.5% after the 4th intramuscular dose, 12.5% after the 5th and 10% after 3.5 +/- 0.5 (mean +/- SEM) intradermal inoculations. The mean antibody titers were 1,461 +/- 98 mIU/ml in group A, 594 +/- 684 in group B and 131 +/- 133 in group C. In conclusion, our two-step integrated protocol gives an anti-HBs protective titer in all our patients.

Female↗