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Biomedical subjects

G Colussi

Publications and source records attributed to G Colussi.

At least 55 records · Page 3Linked to original sources

Parathyroid glands in primary hyperparathyroidism: an ultrastructural study of 50 cases.

Parathyroid glands from 50 cases of primary hyperparathyroidism were examined by light and electron microscopy in an attempt to elucidate the diagnostic role of electron microscopy in this disease. In the cases in which only one gland was removed at surgery, a final diagnosis by light microscopy was not possible. The electron microscopic findings for some of these single glands (e.g., ribosomal-lamellar complexes and groups of centrioles) suggested that they were adenomas. In cases in which two or more enlarged glands were removed, a correct final diagnosis could be made on the basis of the light microscopic findings alone, and electron microscopy provided no further significant information. Where one enlarged gland and one normally sized gland were removed, electron microscopy disclosed important findings in the normally sized glands. Specifically, light microscopic examination of normally sized glands suggested endocrine suppression, while electron microscopy showed chief cell activity, thereby changing the final diagnosis from adenoma to hyperplasia. The clinical follow-up assessment in some of these patients confirmed the electron microscopic findings. Therefore, the incidence of adenoma in patients with primary hyperparathyroidism should be critically re-evaluated by ultrastructural studies of the normal glands that should be removed with the enlarged ones.

Adult↗

High fluid intake or pharmacological therapy in recurrent stone former patients?

In order to evaluate whether therapy can reduce relapses of urinary stone formation, we have retrospectively analysed the long-term follow-up of 55 recurrent stone former patients either treated with high fluid intake and moderate low calcium and low oxalate diet alone (Group A 18 patients), or with the same dietetic advice plus hydrocholorothiazide, amiloride and allopurinol (Group B 37 patients). In group A, stone recurrence was completely abolished in 14 patients without hypercalciuria and hyperuricuria, but not in the four patients with hypercalciuria and hyperuricuria. In group B, no relapses were observed in 19 hypercalciuric and hyperuricuric patients during a cumulative follow-up of 91 years. Even if the other 18 patients had relapses during a cumulative follow-up of 89 years, they showed a significant decrease in stone/patient and stone/year rates. It is concluded that high fluid intake and diet can actually prevent stone recurrence in patients without hypercalciuria and hyperuricuria, but in hypercalciuric and hyperuricuric patients treatment with diuretic and allopurinol is better.

Allopurinol↗

Vitamin D metabolites and osteomalacia in the human Fanconi syndrome.

Experimental evidence suggests that renal 1 alpha-hydroxylase activity is impaired in Fanconi syndrome. We have evaluated plasma vitamin D metabolites in five patients with Fanconi syndrome, three of whom had metabolic bone disease; plasma 1,25(OH)2D3 was low in the three patients with bone disease, and normal in the two patients without a bone mineralisation defect. The data supports the hypothesis that renal 1 alpha-hydroxylase activity may be impaired in human Fanconi syndrome, and that altered vitamin D metabolism may contribute to the pathogenesis of metabolic bone disease in Fanconi syndrome.

Aged↗

Lupus nephropathy and pregnancy. A study of 26 pregnancies in patients with systemic lupus erythematosus and nephritis.

We describe 26 pregnancies in 19 patients with lupus nephritis. There were 4 spontaneous abortions, 2 therapeutic abortions, 4 stillbirths and 1 neonatal death. 10 deliveries were preterm and 2 fetuses were small for gestational age. 8 pregnancies were not accompanied by change of renal symptoms. Mild signs of renal involvement appeared during pregnancy in 4 patients. 6 patients showed an increase in proteinuria already present before pregnancy without renal function deterioration. A moderate worsening of renal function was observed in 3 patients. 4 patients, 3 of whom had an apparent onset of systemic lupus erythematosus during pregnancy, developed anuric acute renal failure after delivery or after late spontaneous abortion. 2 of them died from sepsis and disseminated intravascular coagulation while 2 had complete recovery of renal function. A high rate of complications was observed in patients not adequately treated during pregnancy. Renal biopsy before gestation was not predictive of the outcome of nephropathy during pregnancy, and change of histology in repeated biopsies was frequently observed.

Abortion, Spontaneous↗

Immunological monitoring of viral infections in renal transplant recipients.

Twelve viral episodes occurred in 54 antilymphocyte globulin-treated renal transplant recipients (two primary cytomegalovirus, seven cytomegalovirus reactivations, one chickenpox, two influenza). In 11 of 12 cases the ratio between peripheral T4 and T8 subsets fell (from 1.698 to 0.986, p less than 0.01) due both to a reduction of T4+ and to an increase of T8+ cells. T10+ and 5/9 subsets also increased. Suppressor T-cell function, as measured by two simultaneous assays, was enhanced. In antibody-negative CMV patients the reversal of T4/T8 ratio preceded the appearance of specific IgM. T4/T8 ratios rapidly returned to normal in mild episodes, but remained reverted in symptomatic CMV patients for several months, despite a reduction in the immunosuppressive regimen. Symptomatic viral episodes displayed marked imbalances in T cell subset numbers and function, while in asymptomatic cases the changes were less evident.

Chickenpox↗

Relationship between sodium intake, proximal tubular function and calcium excretion in normal subjects and in idiopathic hypercalciuria.

Proximal tubular function was studied with maximal water clearance studies in 15 controls (C), 22 Ca stone formers with idiopathic hypercalciuria (IH) and 10 normocalciuric Ca stone formers (NC). Distal delivery of glomerular filtrate (ClDD) and Na excretion were higher in IH and NC than in C; NaCl loading (6 g/day) for seven days in C increased Na excretion and ClDD to similar levels as in IH and NC; the distribution of ClDD for any level of Na excretion was similar in C, NC and IH. NaCl loading in C slightly reduced renal phosphate threshold, which still remained higher than in IH on a free diet. It appears that reduced tubular reabsorption of glomerular filtrate in Ca stone formers is related to habitual high Na intake and is not peculiar to hypercalciuric patients. Habitual high Na intake is unlikely to be responsible for all the metabolic spectrum of idiopathic hypercalciuria.

Adolescent↗

Acetohydroxamate in struvite stones: in vivo study.

This report describes the results obtained with a combination of acetohydroxamic acid (AHA) and antibacterial agents in 13 patients with recurrent struvite stones complicated by refractory infections with urease-producing bacteria. Intravenous antibiotic pulses plus oral AHA achieved urine sterilisation in all. Then oral chemotherapy plus AHA was given for a mean period of 10.8 +/- 5.4 months. In four patients, the urine remained sterile, but in all the patients urinary pH remained below 6.4 and urinary NH4+ below 40 mg/dl. Despite the persistence of urea-splitting bacteria, the radiographic data showed an arrest of stone growth during the first year of treatment.

Anti-Bacterial Agents↗

Prevention of calcium nephrolithiasis with low-dose thiazide, amiloride and allopurinol.

We report 5 years' experience with low-dose hydrochlorothiazide, 50 mg/day and amiloride, 5 mg/day, in 519 patients with recurrent calcium nephrolithiasis. Additional treatment with allopurinol, 100 mg/day was prescribed for approximately 50 percent of the patients. All patients had active stone formation, having 3,464 stones in 3,126 patient-years (6.67 stones per patient, 1.10 stones per year). Hypercalciuria was present in 65 percent of the patients and hyperuricosuria in 24 percent. The administration of low-dose hydrochlorothiazide was effective in reducing urinary calcium excretion in most patients. It is possible that the hypocalciuric effect of hydrochlorothiazide were enhanced by amiloride, an agent which has been shown to cause hypocalciuria when given alone. Significant side effects requiring discontinuation of the drug were observed in only 5 percent of the patients. During 872.8 patient-years of treatment, only 53 new stones were formed (0.10 stones per patient, 0.06 stones per year) in contrast with the 916 predicted ones. The difference (chi-square) is statistically significant (p less than 0.001). These results show that the administration of low-dose hydrochlorothiazide and amiloride, either alone or in association with allopurinol, is clinically effective in reducing the rate of recurrence of calcium nephrolithiasis.

Adult↗

Acute renal failure in 11 children with non-Hodgkin lymphoma.

Twelve episodes of acute renal failure (ARF) in 11 children hospitalised for non-Hodgkin lymphoma (NHL) are reported. Six of 11 were classified as abdominal Burkitt type lymphoma, three as lymphoblastic convoluted cell lymphoma, and two as lymphoblastic lymphoma. Oliguria was present in six cases. Duration of ARF ranged from 3 to 23 days. Only one child required peritoneal dialysis. According to possible mechanisms of renal injury patients were divided into three groups: neoplastic renal infiltration (5 cases), uric acid intratubular precipitation (5 cases), treatment-related ARF (2 patients). ARF was always reversible, regardless of aetiology.

Acute Kidney Injury↗

Renal lesions in essential mixed IgG-IgM cryoglobulinemia. Study of 48 cases.

56 renal biopsies in 48 patients affected by essential mixed IgG-IgM cryoglobulinemia have been examined by light microscopy and immunofluorescence. Patients were classified in four groups: 1) minimal lesions (4 patients); 2) pure proliferative mesangial lesions (9 patients); 3) membranoproliferative glomerulonephritis (23 patients); 4)proliferative glomerulonephritis with prominent intraluminal thrombi (12 patients). In this last group large intraluminal thrombi intensely fixing anti-IgG and IgM antisera were present; unlike the preceding groups, few deposits on capillary walls were seen. These four groups differed in renal clinical syndrome at presentation: in particular, proteinuria or nephrotic syndrome was the predominant manifestation in group 3, acute nephritic syndrome in group 4. In the latter, reversal of renal failure and regression of lesions could be observed. Various morphological aspects tend to show that in this disease more than one mechanism is operating in producing renal damage, including local trapping of abnormal circulating proteins.

Cryoglobulinemia↗

Lisuride hydrogen maleate: evidence for a long lasting dopaminergic activity in humans.

In 12 acromegalics a single oral dose of 0.2 mg lisuride, an ergoline derivative, significantly reduced plasma PRL but not GH concentrations. Three-tenths milligram of the drug significantly reduced plasma levels of the two hormones. Four-tenths milligram of lisuride did not augment this inhibitory effect. Plasma PRL levels were suppressed in all patients, whereas GH levels were reduced by more than 50% of the base-line values in only seven patients who also responded to the administration of 2.5 mg bromocriptine (CB154). In the patients unresponsive to lisuride, CB154 also failed to change GH levels. The suppressive effect of lisuride started at 60 min (at 150 min for CB154) and plasma GH and PRL levels were still markedly suppressed at 300 min. Plasma GH and PRL concentrations were consistently reduced in two acromegalic patients during 2 weeks of chronic treatment with 0.3 mg lisuride four times a day. In six normal subjects, TRH-induced PRL release was significantly inhibited by pretreatment with 0.3 mg of the drug. The similarity in the effects of lisuride and CB154 suggests that the observed effects of lisuride on GH and PRL are attributable to the known dopaminergic activity of the drug. This conclusion is supported by the data showing that pimozide effectively counteracted the inhibitory action of lisuride on GH and PRL release. We suggest that lisuride may be of value in the medical treatment of acromegaly and hyperprolactinemic states.

Acromegaly↗