Biomedical subjects

G Forneris

Publications and source records attributed to G Forneris.

23 records · Page 2Linked to original sources

PubMedDate not supplied

[Peritoneal complications of continuous ambulatory peritoneal dialysis].

Aim of this work is an analysis of the clinical and microbiological aspects in 205 peritonitis episodes occurred in 156 patients admitted on peritoneal dialysis from January 1980 to December 1989. The evaluation of causative organisms shows a high prevalence of Gram+ organisms (60% of cases), while Gram- organisms are responsible for 16% of peritonitis episodes and fungi for 4%. No cultural growth was observed in 13% of the cases, while more than one organism occurred in 7%. Peritonitis incidence decreased from one episode every 3.9 patient months during 1980-81 to one every 33.6 patient months during 1988-89. This improvement is especially related to the employment of Y-set connection system and to the sterilization of connection lines by amuchina. From 1984 Y-set was used in each of the new patients admitted on CAPD. After its employment peritonitis incidence decreased from one episode every 6.2 patient months to one every 29 patient months. In our experience vancomycin i.v. proved to be effective and well tolerated. In no case a persistence of infectious disease was observed and no catheter was removed.

Equipment Contamination↗

PubMedDate not supplied

[Atherosclerotic vascular nephropathy. Description of 2 clinical cases and review of the literature].

Atheromatous nephropathy, due to a reduction of arterial blood flow caused by stenosis or thrombosis of renal arteries, is now recognized as an important cause of chronic renal failure in the elderly. It has been shown that renal revascularization may allow a recovery of renal function up to the withdrawal of dialytic treatment. Digital arteriography is the preferred diagnostic method, but doppler scan and renal scintigraphy after administration of captopril may also prove useful, specially in the follow-up of the patients. Therapeutic means include percutaneous transluminal angioplasty and surgical revascularization; both treatments may improve or stabilize renal function. Surgery may allow better results in the long term, but is loaded by a significant morbidity. Our experience confirms the possibility to obtain a significant long term improvement of renal function after bilateral surgical revascularization.

Acute Kidney Injury↗

PubMedDate not supplied

[Clinical and instrumental surveillance of the arteriovenous fistula].

Stenosis and thrombosis are the most important complications leading to vascular access failure in hemodialysis (HD). Aiming for an early access dysfunction diagnosis and elective repair of the failing access, the DOQI guidelines recommend that all HD patients undergo a program of regular monitoring and surveillance. The K/DOQI 2000 update identifies specific types of evaluation for dialysis accesses. First nephrologists should examine patients by inspecting, ausculting and palpating the access at least every 4-6 weeks when patients are not being dialyzed. In addition, access surveillance should be regularly performed by various techniques, i.e. urea recirculation test, dialysis venous pressure measurement and access blood flow assessment. Recently many methods have been proposed and implemented. Ultrasound dilution is the most commonly used. This technique relies on the change in ultrasound velocity when blood is diluted with a normal saline bolus at a known dialyzer blood flow rate, after the lines have been reversed. Following the use of blood ultrasound dilution, multiple technologies have been implemented for access flow measurement with line reversal, i.e. hematocrit (Hct) dilution, thermodilution, conductivity variation assessment. There are three other methods that do not require line reversal: i.e. transcutaneous access flow (TQA) assessment, glucose pump test (GPT) and the variable flow Doppler. Finally, duplex scanning can provide both the anatomy and blood flow of the access. With a Qa <600 mL/min or <1000 mL/min, but reduced by 25% in 4 months, K/DOQI suggest performing angiography and eventual elective repair.

Blood Flow Velocity↗

PubMedDate not supplied

[Effects of erythropoietin on the cardiovascular system and the intradialytic hemodynamic behavior].

The aim of the study was to evaluate, before and after hemodialysis (HD), the effects of partial correction of anemia with erythropoietin on: cardiac index (CI), stroke index (SI), heart rate (HR), ventricular ejection index (EVI), mean arterial pressure (PAM) and systemic vascular resistance index (SVRI). Cardiac parameters were gathered by means of transthoracic bioimpedance (BoMed). Twelve patients (6 M, 6 F) aged 50.6 +/- 5 years, on HD for 92.8 +/- 15.9 months, were studied twice (basal, end of follow-up). Before rHuEPO therapy, 6 patients had a "pathologic" cardiac response to HD (defined as an increase of CI despite the reduction of pre-load). After rHuEPO, 5 out of 6 patients with a "pathologic" response reverted to a "normal" response, and 1 hypertensive patient from a "normal" to a "pathologic" response. The EVI, CI and SI of patients with "pathological" response significantly improved after rHuEPO as compared with pre rHuEPO values (EVI 1.36 +/- 0.14 vs 1.07 +/- 0.08, p = 0.023; CI 3.18 +/- 0.24 vs 1.78 +/- 0.27, p less than 0.01; SI 43 +/- 3.7 vs 24 +/- 3.8, p less than 0.01). In conclusion, partial correction of anemia with rHuEPO induces an improvement of myocardial performance, without significant hemodynamic adverse effects. Our results suggest also that anemia could play a significant role in the pathogenesis of myocardial disfunction in HD patients.

Adult↗

PubMedDate not supplied

[Biofiltration without buffering substances in the dialysate].

A new hemodiafiltration technique, acetate free biofiltration (AFB), has been recently introduced in the treatment of chronic uremia. It is performed with a buffer free dialysate and a simultaneous infusion in post-dilution mode of a sodium bicarbonate solution (concentration 145-166 mEq/l; infusion rate 1.2-2 l/h). A polyacrylonitrile hollow fiber AN69 HF 1.2 sqm dialyzer is employed. In acute studies pCO2 remains stable throughout the treatment, as well as pCO2. We have found a significant inverse correlation between delta[HCO3-] pre and post treatment and basal [HCO3-] (r = -0.88; p less than 0.001), with an excellent correction of uremic acidosis, avoiding post dialytic alkalosis. Our long term experience on 6 patients followed up to 31 months, allows us to consider AFB as a feasible and safe treatment, offering a good correction of uremic acidosis and an excellent hemodynamic tolerance. We propose AFB as a competitive technique with respect to bicarbonate hemodialysis, hemodiafiltration and standard biofiltration.

Acidosis↗