Biomedical subjects

G Paternoster

Publications and source records attributed to G Paternoster.

9 recordsLinked to original sources

PubMed2002

Monopharmacologic general anaesthesia with sevoflurane in paediatric patient with Prader-Willi syndrome.

Prader-Willi syndrome (PWS) is a genetic disease caused by a loss of paternal genes located in chromosome 15. Children affected by this syndrome often have preterm delivery; during childhood the hallmarks are: severe infantile hypotonia and feeding problems. Afterward, neurologic manifestations, endocrine signs and dysmetabolic abnormalities are usually seen together with craniofacial manifestations and musculoskeletal abnormalities. Obesity causes sleep abnormalities including sleep apnea. The case we present is of a 5 year old child (CA) scheduled for strabismus surgery. The child has a lot of typical (PWS) signs. A number of anaesthesiologic problems are associated with (PWS). Some of them relate to obesity, others to facial dysmorphism. Moreover, the syndrome may give a prolonged and exaggerated response to every sedative drug. P.W.S. is also characterized by thermoregulatory disorders. Sleep apnea occurs often. Considering all these problems, we planned a monopharmacologic anaesthesiologic procedure using sevoflurane.

Anesthesia, Inhalation↗

PubMed1999

[Dialysis in the elderly. Indications for and efficacy of hemodialysis].

In Italy, as in all industrialized countries, life expectancy is raised during the past 100 years; this trend leads to important implications in medicine and among nephrologists. The increased number of end stage renal disease patients living beyond 65 years, who start dialysis, has modified the typical picture in dialysis centers. The causes of this phenomenon are different, including an increasing number of chronic diseases, typical of the "third age", like type II diabetes mellitus or vascular disease, creation of treatment facilities and success of prevention. Besides goods results obtained in elderly dialysis patients, mainly due to a better psychological reaction to the treatment and to an easy achievement of a high dialytic dose (Kt/V), there are some negative aspects, like the hemodynamic intolerance or the difficulties to make an ideal vascular access. However, these problems don't discourage the nephrologist but rather they must lead to achieve a personalized or alternative treatment. Even if the quality of life and rehabilitation are quite acceptable in many elderly patients, so to justify the wide acceptance criteria, many ethical and medical problems concern the most serious cases. Also in this condition, a wide acceptance criteria, followed by a possible withdrawal (time limited trial of treatment), can represent a reasonable solution.

Aged↗

PubMed1998

[Emergency and temporary vascular access].

The vascular access in emergency represents a basic need for every nephrologist in order to realize an extracorporeal circuit necessary to perform hemodialysis and many other derived therapies. In the eighties a progressive abandonment of the external shunt was noted with a concomitant increase of vena cava catheterization simpler to perform, especially under echographic control, and made increasingly possible by continuous technological improvements. The femoral access is utilized in about 30% of cases, especially in critically ill patients, due to easy performing procedures and few complications. Subclavian vein is abandoned as a first choice in favour of the jugular vein due to frequent and severe early complications and to thrombo-stenotic lesions observed in about 50% of catheterizations. Prevention and rapid treatment of the complications and careful management have an important role in obtaining a prolonged catheter survival. Even if, when possible, the classical arterio-venous fistula remains the ideal solution, at least in particular patient categories a jugular vein utilization as permanent access is justified.

Arteriovenous Shunt, Surgical↗

PubMed1987

Renal tolerance of rubidium chloride: short-term clinical evaluation.

The rubidium and lithium ions are known to have opposite effects on a wide range of biochemical and behavioral parameters in experimental animals. Based on the proven effectiveness of lithium as an antimanic agent, several trials have been conducted with rubidium in the acute treatment of the depressive phase of bipolar illness. The results to date are promising. However, the 30- to 60-day biologic half-life of rubidium has mandated careful studies of potential toxicity before engaging in long-term administration of this ion to depressive subjects. One area of potential concern is the possibility of renal toxicity, which could be expressed as unexpectedly increased retention of rubidium. The data in this paper show that after 15 days of rubidium administration, there are no changes beyond the normal range in a variety of kidney function tests, including in four enzymes which are specific markers of tubule cell function.

Aged↗

PubMed1987

Histological changes and histamine release induced by dactimicin in isolated perfused rat kidney.

The nephrotoxicity of aminoglycosides has been the object of numerous works of research showing that different molecules belonging to the same family of antibiotics can exert their toxic action in different ways. The aim of the present research was to evaluate the nephrotoxicity of dactimicin (DTC), a recently synthesized aminoglycoside antibiotic, as compared to gentamicin (GTM), amikacin (AMK) and fortimicin (FTM). The experimental model used was the isolated perfused rat kidney, and the parameters evaluated were histamine release and histological findings. The results showed that GTM was able to induce a significantly higher release of histamine than AMK, FTM, or DTC. AMK provoked a higher level of histamine release than FTM or DTC, although the differences between the three were not significant. Histological preparations obtained with GTM revealed large-scale lesions, which however were less detectable with AMK, and much less with DTC.

Aminoglycosides↗

PubMed1987

Comparative effects of gentamicin, amikacin and dactimicin on excretion of N-acetyl-beta-D-glucosaminidase (NAG) and kidney histological pattern in rats.

Dactimicin (DC) is a new pseudodisaccharide aminoglycoside antibiotic containing a formimidoyl group in its molecule (1). DC exhibits a greater antibacterial activity than other aminoglycosides against the clinical isolates of Serratia marcescens and is active against many gentamicin- and amikacin-resistant bacteria. This characteristic of the drug appears to be linked with a probable protective action exerted by the formimidoyl group in its structure. The greatest limitation in the clinical use of aminoglycosides is their potential for nephrotoxicity. The present study compares the renal effects of DC versus gentamicin (GT) and amikacin (AK), respectively the most and the least nephrotoxic pseudotrisaccharide aminoglycosides in present use (2), evaluating the urinary NAG excretion and the histological changes induced in the kidney.

Acetylglucosaminidase↗

PubMedDate not supplied

Peritoneal dialysis compared with hemodialysis in the treatment of end-stage renal disease.

Whether to use peritoneal dialysis (PD) or hemodialysis (HD) is a major decision in terms of clinical outcome and management implications; the final choice is difficult because of the conflicting results of comparisons reported in the literature. A review of studies comparing survival shows either superiority of HD, or superiority of PD, or equivalence of the two techniques, but an analysis of the comparisons as a whole brings to light two clear phases in the survival curves. In the first, residual renal function (RRF) gives PD an advantage, or at least puts it on the same level as HD. In the second phase, the reduction in Kt/V as RRF declines gives PD a potential risk. After a few years of PD treatment a sharp watch is therefore necessary to detect signs of under-dialysis promptly and to shift the patient to HD. In patients without RRF it is more difficult to control hypertension with PD and they are more prone to hyperhydration. Despite a widespread belief in the Eighties that PD was the treatment modality of election for diabetics, HD is in fact preferable in these patients, except younger ones. High-turnover and low-turnover bone lesions are more frequent respectively in HD and PD patients. Anemia is better controlled with PD. Blood lipids and nutritional indices are less well controlled with PD. Despite poor technical survival, the "pool" of patients treated with PD frequently reaches 20-30% because it is indicated as first treatment in a large proportion. PD preserves renal function better than HD and is useful while awaiting renal transplantation, with faster postoperative restoration of diuresis. The quality of life with PD as home treatment is usually better than with HD. In conclusion, dialytic centers should establish an integrated PD/HD programme as the two methods are not competitive but are different tools for the treatment and rehabilitation of uremic patients.

Australia↗

PubMedDate not supplied

[Dialysis in the elderly].

Assuming >/= 75 years old as the age limit to define dialysis in the elderly, the incidence in this group of patients is progressively increasing in most dialysis units, with an annual growth of 8 to 16%, and represents 20 to 33% of the overall population being affected. The prevalence of the elderly dialysis group is also high, 14 to 20%, in the main literature casistics. Vascular nephropathies, 13 to 50%, represent the major cause of end-stage renal disease, followed by diabetes, 11 to 37%. First year survival rate is an acceptable 52 to 82%, whereas the fifth year value is on average 20 %, also due to the high baseline mortality in these patients. The death causes are mainly cardiac related and represent 45% of the overall mortality. The main prognostic factors are frequency and severity of comorbid factors, in addition to nutritional indexes that are particularly important in this age group. Dialysis dose and treatment time are not related to mortality. Haemodialysis and peritoneal dialysis complement each other to allow the best results. The survival rate, however, is usually better with haemodialysis, especially in old diabetic patients and after some years of treatment. Vascular access, intradialytic hypotension, cardiopathy, intestinal bleeding and amyloidotic arthropathy represent the more critical aspects of dialysis in the elderly, while the quality of life is sometimes unexpectedly good.

Age Factors↗

PubMedDate not supplied

[Effect of dialytic treatment and the relation between erythrocyte urea and plasma urea].

The existence of an intraerythrocytic binding between haemoglobin and urea is known; it determines, in normals, a higher erythrocyte than plasma urea concentration; this binding, in vitro, is progressive for an urea concentration range of 10-400 mg/dl. The only data found relating to dialysis patients, are reported by Nolph et al.; they indicate a decrease in the plasma-blood urea ratio during the blood transit through the dialyzer and a different ratio in comparison with normals, but in our opinion the method used to measure urea concentration was unsuitable. We determined urea distribution ratios by measuring, in blood and plasma, water and urea concentration in uremic inflow and outflow blood samples during dialysis. Our data indicate 1) an increase in outflow erythrocyte water (H2Oe inflow: 0.659, H2Oe outflow: 0.671 P less than 0.01) induced by a different erythrocyte osmotic gradient; 2) a not different ratio between urea of erythrocyte water and urea of plasma water in inflow and outflow samples of dialysed patients and in normals (respectively 1.06, 1.16, 1.13 p = n.s.). Our data from normal and uremic patients are like those found by Murdaugh & Doyle and by Colton & Lowrie in normals.

Body Water↗