PubMed Health⌕ Search

Biomedical subjects

G Di Filippo

Publications and source records attributed to G Di Filippo.

11 recordsLinked to original sources
PubMed2006

Reduction in urea distribution volume over time in clinically stable dialysis patients.

We have previously shown that, assuming urea distribution volume (V) remains constant for 1 month, ionic dialysance (ID) allows the dialysis dose to be calculated without the need for blood sampling. The aim of this multicenter study was to verify whether the assumption of a constant V can be extended to 1 year. In clinically stable patients receiving thrice-weekly hemodialysis at 13 dialysis centers, V and Kt/V were assessed during three dialysis sessions at baseline and 1 year later using ID as dialyzer urea clearance and the single-pool urea kinetic model. Baseline albumin, hemoglobin, and C reactive protein were prespecified covariates for predicting the change in V over time. Of the 52 enrolled patients, 40 (25 males; age 63.0+/-13.5 years) completed the study. Baseline end-dialysis body weight (62.4+/-13.7 kg) showed a non-significant 1% reduction during follow-up (-0.6+/-2.8 kg; P=0.175), whereas V significantly decreased from 29.0+/-6.8 to 27.4+/-6.0 l (-1.6+/-3.0 l or 4.5%; P=0.002). The reduction in V was greater when baseline albumin was lower (P=0.001) and baseline V was higher (P=0.005). The single-pool K(t)/V calculated using baseline V underestimated the actual value by 0.07+/-0.16 (P=0.008). The slight underestimate of Kt/V during follow-up suggests that annual V evaluations may be sufficient for dialysis dose quantification as the only risk is underestimating the actually delivered dialysis dose. However, the relationship between baseline albumin and the reduction in V over time may have nutritional value, and suggests more frequent V evaluations.

Adolescent↗
PubMed1997

[Pancreatic fractures: the role of CT and the indications for endoscopic retrograde pancreatography].

PURPOSE: To assess the role and the diagnostic yield of CT and of endoscopic retrograde cholangiopancreatography (ERCP) in the study of emergency pancreatic injuries from blunt abdominal trauma. MATERIAL AND METHODS: January, 1992, to December, 1996, eleven subjects with pancreatic trauma were operated on. The patients were 8 men and 3 women (mean age: 28.4 years, range: 15-47 years) with pancreatic traumas of different severity but all with gland fracture and severe ductal injuries. Direct radiography was performed in all cases in different projections: CT with 1 cm slice thickness and feed was also performed. A contrast agent was administered orally in 8/11 patients and i.v. in 11/11. ERCP was performed in supine recumbency within 12 hours of trauma; a hypotonic agent was administered i.v. in 5 cases. The examination was successful in 10 patients. Wirsung duct studies were extended to the biliary tract in 6 cases. RESULTS: Pancreatic traumas were never isolated and usually associated with other abdominal injuries in the liver, spleen, small intestine, kidneys (by frequency) and with injuries in other body regions--the chest in 8/9 cases, limbs in 7/9, the spine in 4/9 and the skull-brain in 3/9 cases. Pancreatic fractures were mostly cervical and 3 of them were bifocal. The radiologic findings of pneumoperitoneum (4 cases), sentinel loop (3), paralytic ileum (11), air-fluid levels (9) were always aspecific. CT had 66.7% sensitivity, with over-all accuracy of pancreatic involvement by trauma in 5/11 cases and specific findings of fracture in 1/11 cases. CT showed associated parenchymal injuries in both the abdomen and other sites. ERCP diagnostic accuracy and sensitivity topped 100% in the demonstration of ductal injuries. DISCUSSION: Pancreatic traumas are usually a rather uncommon event. They are classified as major and minor according to the extent and severity of ductal involvement. Injury site corresponds to the direction of impact force, but the neck is the preferential site for fractures because it is compressed within the spine and extended. Clinical findings are usually aspecific and questionable and diagnostic imaging, especially CT, plays therefore a major role in treatment planning. However, CT provides mainly indirect signs and fails to depict ductal rupture. Despite its difficult technical execution in emergency, ERCP shows ductal injuries with extreme accuracy and specificity, which finding is indispensable for treatment planning. CONCLUSIONS: Both CT and ERCP are necessary tools to diagnose pancreatic fractures: the former because it provides indispensable panoramic findings and the latter because it is the only method showing ductal involvement. Therefore, both techniques should be used for accurate surgical planning, which is a crucial step for the prognosis of these injuries. Cost-effectiveness and safe execution are well balanced.

Abdominal Injuries↗
PubMed1991

Forecasting correct sodium balance in hemodiafiltration procedures involving infusions.

Four patients, stable on acetate hemodialysis (AHD), were switched to acetate-free biofiltration (AFB) which differs from AHD and bicarbonate hemodialysis (BHD) in that the dialysate contains no buffer, which is given intravenously as a hypertonic (1/6 M) Na bicarbonate solution. Within the 1st month the patients developed thirst and hypertension attributed to a positive Na balance. The aim of this investigation was to check this (1) by a study based on the predictable changes induced in the body compartments of 13 patients by the infusion and ultrafiltration (UF) of a hypertonic solution and (2) by direct determination and calculation of 28 Na mass balances in BHD and AFB. The theoretical model indicated that infusion of 4.87 liters of a 166.7 mEq/l Na bicarbonate solution and UF of the same amount caused a positive balance of 233 mosm of Na. The Na mass balances showed a relationship between Na transmembrane gradient and loss or gain of Na in both methods (p less than 0.0001). The slopes of the regression lines were not significantly different but there was a highly significant difference between the y axis intercepts (p less than 0.0001), which indicates that the same Na transmembrane gradient that gives no net change of Na in BHD, induces a net gain of 240 mosm (120 mEq of Na) in AFB and that to obtain the same Na balance dialysate Na should be reduced by about 8 mEq/l in AFB. These data are the same as the theoretical forecast which could be extended to all hemodiafiltration methods in which solutions of any tonicity have to be infused, in order to correctly predict the Na balance.

Body Fluid Compartments↗
PubMed1979

Hemodialysis with "adequate" sodium concentration in dialysate.

This investigation was undertaken to define the "adequate" sodium concentration in the dialytic fluid allowing to maintain a stable plasma effective osmolality during dialysis. Isonatric dialysate is shown to miss this aim by inducing a predictable postdialytic hypernatremia. To avoid this effect a new approach was made. 17 clinically stabilized patients, previously dialyzed over a period of at least 2 years with a dialysate sodium concentration of 133 mEq/l, underwent dialysis with the "adequate" sodium concentration in the dialysate for over 3 years. During dialysis cramps, headache, hypotension, hypertensive crises and postdialytic weakness were reduced in frequency and nearly disappeared. No deterioration in blood pressure control occurred and improvement in some general parameters (hematocrit, glucose and insulin metabolism, well-being) was reported after prolonged treatment.

Adult↗