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G Ancona

Publications and source records attributed to G Ancona.

At least 19 recordsLinked to original sources
PubMed2000

Tumour necrosis factor-alpha gene polymorphism: implications in kidney transplantation.

In this study we have analysed the TNFA biallelic polymorphism at the -308 position, in 169 kidney recipients that received the graft in a single Italian transplantation facility and we have then correlated the TNFA genotypes with the post-transplant outcome. To assess the cytokine genotypes, a polymerase chain reaction-sequence specific primer (PCR-SSP) methodology has been utilised. By the analysis of the different genotypes, the corresponding TNF-alpha phenotypes and the level of the TNF-alpha production, were deduced: the TNF(*)1/TNF(*)1 genotype gives a low TNF-alpha production level, TNF(*)1/TNF(*) 2 and TNF(*)2/TNF(*)2 genotypes give a high TNF-alpha production level. Out of the one hundred and sixty-nine patients studied, one hundred and twenty-one recipients (72%) had a low TNF-alpha producer phenotype, whereas forty-eight (28%) had a high TNF-alpha producer phenotype. These frequencies were not statistically different from those of the control group. The incidence of acute rejection episodes, vascular damage (grade III degrees of Banff classification), and serum creatinine levels at 1 month, were significantly greater in high TNF-alpha producers (P=0. 048, 0.031 and 0.007 respectively). The logistical regression model indicated that only the high producer genotype and donor age were significantly and independently correlated with acute graft failure (P=0.02 and P=0.013 respectively). This analysis shows that recipient TNFA polymorphism, previously associated with differential production TNF-alpha by in vitro studies could be related to the clinical outcome of kidney transplantation.

Adult↗
PubMed2000

An objective method for detecting time-dependent effects in graft survival.

The proportional hazards model has become increasingly important in the analysis of censored survival data after transplantation. Neverthless, in clinical transplantation it is still undefined how the influence of covariates changes over time. The additive regression model is an alternative (or extension) to the Cox model. It results in plots (Aalen plots) that may give information on the effect of covariates over time by way of the cumulative regression function plots. A total of 386 primary cadaveric kidney transplants performed between 1984 and 1996 were included in our analysis. The follow-up period ranged from 24 to 156 months. According to Aalen, an additive regression model was used and plots for the detection of time-dependent effects of covariates were determined. Patients dying with functioning grafts were classed as graft failures. Factors potentially affecting graft outcome, such as sex, donor and recipient's age, HLA A-B match, cold ischaemia time (CIT), delayed graft function (DGF), serum creatinine at 1 month (Cr1), rejection episodes within 3 months (R3), and type of brain death (BD), were considered. The slopes of the plots by donor age, DGF, HLA A-B match, R3, Cr1 and BD appear to have a significant influence throughout the observation period, with different time-dependent effects on graft survival. Slopes for DGF, Cr1, and age of donor are positive (increased hazard), while slopes for HLA match and BD are negative (decreased hazard). Estimated regression functions for DGF, donor age and Cr1 show a prompt slope (within 3 months); the covariate R3 has a clear influence for about 5 years, and then seems to disappear; and BD appears to have a consistent effect over the entire period. The additive regression model with Aalen plots represents a useful technique in the analysis of survival data after kidney transplantation. Some covariates, such as R3, may often lose their effects on graft survival, with a relevant clinical impact. Others have a clear and additive influence over the entire period (BD), while the effects of donor age, DGF and CR1 each appear to have a prompt effect in the outcome.

Adult↗
PubMed2000

Compensation for increase in respiratory workload during mechanical ventilation. Pressure-support versus proportional-assist ventilation.

Variation in respiratory impedance may occur in mechanically ventilated patients. During pressure-targeted ventilatory support, this may lead to patient-ventilator asynchrony. We assessed the hypothesis that during pressure-support ventilation (PSV), preservation of minute ventilation (V E) consequent to added mechanical loads would result in an increase in respiratory rate (RR) due to the large reduction in tidal volume (VT). WITH proportional-assist ventilation (PAV), preservation of V E would occur through the preservation of VT, with a smaller effect on RR. We anticipated that this compensatory strategy would result in greater patient comfort and a reduce work of breathing. An increase in respiratory impedance was obtained by chest and abdominal binding in 10 patients during weaning from mechanical ventilation. V E remained constant in both ventilatory modes after chest and abdominal compression. During PSV, this maintenance of VE was obtained through a 58 +/- 3% increase in RR that compensated for a 29 +/- 2% reduction in VT. The magnitudes of the reduction in VT (10 +/- 3%) and of the increase in RR (14 +/- 2%) were smaller (p < 0. 001) during PAV. During both PSV and PAV, chest and abdominal compression caused increases in both the pressure-time product (PTP) of the diaphragm per minute (142.9 +/- 26.9 cm H(2)O. s/min, PSV, and 117.6 +/- 16.4 cm H(2)O. s/min, PAV) and per liter (13.4 +/- 2.5 cm H(2)O. s/L, PSV, and 9.6 +/- 0.7 cm H(2)O. s/L, PAV). These increments were greater (p < 0.001) during PSV than during PAV. The capability of keeping VT and V E constant through increases in inspiratory effort after increases in mechanical loads is relatively preserved only during PAV. The ventilatory response to an added respiratory load during PSV required greater muscle effort than during PAV.

Adult↗
PubMed1998

Oral granisetron as prophylaxis for nausea and vomiting during fluorescein angiography. A multicentre, double-blind, randomised, parallel group, placebo-controlled study.

BACKGROUND: Prophylaxis with oral Granisetron was assessed in patients undergoing fluorescein angiography (FAG) in order to evaluate its efficacy in reducing patients' discomfort due to nausea and vomiting (4% > 20%) and to ensure completion of the investigation. EXPERIMENTAL PLAN: Multicentre, randomised, double-blind, placebo-controlled study, with a follow-up visit performed 24 hrs after FAG. ENVIRONMENT: Five Anaesthesia/Resuscitation and Ophthalmology operational units participated in the study. PATIENTS: 120 patients (24 from each Centre) of both sexes and aged > 18 years, suffering from retinal disorders, were enrolled after informed consent. Pregnancy, lactation, anti-neoplastic treatment, ASA status IV/V were main exclusion criteria. All recruired patients completed the study. INTERVENTIONS: Ophthalmological evaluation was performed 30 days before and the same day as FAG. Anaesthesiological assessment on the same day as FAG, recording, BP, HR, ASA status, allergic diathesis, allergy to medications and contrast media, concomitant treatments. Oral Granisetrom 1 mg or placebo was given on an empty stomach 1 hr before the injection of 5 ml 20% fluorescein in 3 sec. A follow-up examination was done 24 hrs after FAG. SURVEY: In both groups nausea, retching and vomiting were seen after fluorescein injection. RESULTS: The study demonstrated that Granisetron is more active than placebo in controlling nausea (3 cases vs 4), and retching (2 vs 6). It was significantly more effective than placebo in the prevention of vomiting (0 vs 3). Efficacy was evaluated with chi 2, p < or = 0.05). CONCLUSIONS: The results suggest that Granisetron may be indicated as prophylaxis in patients undergoing FAG in order to prevent or control emesis, improve patients' comfort and ensure successful outcome of the investigation.

Administration, Oral↗
PubMed1992

Renal needle biopsy of the transplant kidney: vascular and urologic complications.

The authors reviewed the complications of 114 needle biopsies performed in 103 transplant kidneys. The diagnostic and therapeutic approach has changed markedly as a result of the introduction of Doppler ultrasound and the possibility of selectively embolizing fistula tracts. Macroscopic haematuria was the most frequent complication (5%); in one case it appeared 1 week after biopsy and was complicated with obstructive anuria due to a pyeloureteric clot. The incidence of arteriovenous fistulae was fairly low (0.9%); a selective renal angiography was performed, confirming the vascular lesion and allowing its selective embolization. Perirenal blood collections were also rare and the amounts were small.

Adult↗
PubMed1983

[Urologic complications in kidney transplants: experience in 274 transplants].

The urological complications after a renal transplantation still represent an event anything but rare, ranging, according to the different statistics, from 0.9% up to 23%, with a mortality between 0 and 25%. In this work done by the Verona Centre the experience on 274 transplantations is reported. The urological complications weighed with 6.2% and absence of mortality among the patients. The importance of the prevention and precocious diagnosis is confirmed.

Adolescent↗
PubMed1980

[Relation between cytomegalovirus infection and the so-called intolerance to azathioprine in renal transplantation].

Renal transplant recipients can develop hepatic function abnormalities or severe leucopenia after transplantation. Generally it is thought to be due to azathioprine intolerance and patients are treated by curtailment of immunosuppressive therapy, being subsequently at risk to lose their allograft because of rejection. Evidence of Cytomegalovirus (CMV) infection is also common after renal transplantation. It is generally thought that the majority of these infections are asymptomatic, but they can be accompanied by leucopenia and/or hepatic function abnormalities. Sixty-nine renal transplant recipients have been studied for at least three months in order to investigate the relationship between CMV and azathioprine intolerance after transplantation. Twenty-five out of 58 patients who underwent seroconversion to CMV (a fourfold or greater rise in titer of CMV antibodies) after transplantation or who had a high CMV titer (greater than or equal to 1 : 16) prior to transplant, developed azathioprine intolerance. None of 11 patients who before renal transplantation had low CMV titers and who did'nt underwent seroconversion did not tolerate azathioprine. Therefore the Authors advance the hypothesis that azathioprine intolerance following renal transplantation can be often due to an asymptomatic and unknown CMV infection.

Azathioprine↗
PubMed1980

[Significance of mixed lymphocyte culture (MLC) in renal transplants from living donors].

Results of MLC were correlated with kidney-graft survival of recipients of living related donor. The 56 patients tested by MLC were divided into two groups according as the stimulation index was more or less than 5. In 20 of these patients transplanted, renal allograft survival correlated better with low stimulation in MLC, suggesting more histocompatibility.

Graft Survival↗
PubMed1980

[HLA and rejection of renal transplants from cadavers].

Seventy-two patients were typed for HLA-A and HLA-B. Kidney-graft survival, reversibility and time of appearance of reject episodes were comparated with matching level. Matching level had double classification: NIT and Verona; the validity of tissue-typing as prediction of the best result of transplantation and major reversibility of reject episodes.

Cadaver↗
PubMed1980

[Diagnosis and therapy of lymphocele as a complication of renal transplantation].

Of 165 renal transplanted patients, three (1.8%) developed a pelvic lymphocele. Decreased renal function, leg edema, a lower quadrant abdominal mass and fluid retention represented suspicion as the possibility of lymph collection in the perirenal space. Excretory urography associated with pelvic tomography, Computerized Tomography and B scan ultrasound confirmed diagnosis and were helpful in the post-operative follow-up. Drainage procedure restored normal renal function and morphology. External drainage and marsupialization into the peritoneum have been used successfully.

Adolescent↗
PubMed1980

[Aseptic osseous necrosis after renal transplantation].

Of 165 renal Transplantated patients, 12 developed aseptic bone necrosis in the femoral head (6 patients), in the femoral condyle (5 patients), in the astragalus (1 patient). The onset of symptoms was 6 to 23 months after transplantation. 99mTc-O4-MDP bone scintigraphy and radiological examination associated with clinical signs confirmed the diagnosis. Unresolved hyperparathyroidism, phosforus depletion, ponderal increase, total i.v. prednisolone-boluses and trauma represented conditions which might predispose to the development of lesion. 8 patients were managed with conservative treatment. 4 patients required a total of 8 operations: head replacement arthroplasty and articular cartilage reimplant in two patients with disease involving femoral head; articular cartilage reimplant and condyle replacement arthroplasty in two patients with disease involving femoral condyle.

Adult↗
PubMed1979

[Internal arteriovenous fistula in the antecubital region].

An assessment was made of the anterior cubital region as a vascular approach for primary and alternative dialysis. Reference is made to 36 fistulae in this area within 44 months' survival in the drawing of various conclusions with regard to surgical technique. End anastomosis of the median, cephalic or basilic vein laterally on the brachial or radial artery is recommended as a means of preventing or cutting down the more common complications associated with internal arteriovenous fitulae. The anastomosis should not exceed 6 mm in diameter. Complications led to loss of fistula function. In many cases, however, they did not prevent employment of the region for alternative approaches, such as superficialisation of the basilic vein or prosthesis.

Arm↗