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Biomedical subjects

G Viglino

Publications and source records attributed to G Viglino.

35 records · Page 2Linked to original sources
PubMed1992

The impact of peritonitis on CAPD results.

The impact of peritonitis on CAPD results was evaluated in 1990 pts (mean age +/- SD:58.4 +/- 14.8 yrs, 55.9% males), treated in 30 centres participating in Italian PD Study Group, during 1980-89, with an overall observation period of 3953 years (mean +/- SD 24.1 +/- 22.3 months). The incidence of peritonitis decreases from 1.21 (1980-84) to 0.48 (1985-89) ep/year (overall:0.68) with a significant (P < 0.001) reduction of the probability of developing the first peritonitis episode (FPE) through the same periods. The probability of developing FPE and the relative risk of peritonitis were significantly lower (P < 0.001) in pts for whom CAPD has been the first treatment (80.1%); on the contrary these parameters did not gain significant difference according to sex, age 65 years, diabetes or cardiovascular disease. As far as the organisms responsible for peritonitis are concerned a significant reduction of S. epid. and an increase of S. aureus, other Gram pos. and Pseudomonas was observed in the second 5-yr periods. Peritonitis episodes caused catheter removal in 8.2% of cases and were associated with catheter infection in 10.8% of cases. Peritonitis accounted for 24.2% of hospitalization causes and for 6.7% and 30.0% of death and of drop-out respectively. The probability of death and drop-out was significantly high (p < 0.001) in pts with a peritonitis incidence > 1 ep/year than in those with < 0.5 ep/year. The probability of drop-out due to peritonitis was not higher in diabetic or older patients.

Female↗
PubMed1992

Intraperitoneal administration of phosphatidylcholine improves ultrafiltration in continuous ambulatory peritoneal dialysis patients.

Reports in the literature have linked a low phosphatidylcholine content in continuous ambulatory peritoneal dialysis (CAPD) effluent to ultrafiltration loss. Clinical evidence suggests that adding phosphatidylcholine to the dialysis solution enhances ultrafiltration. A clinical study has been designed to clarify the effect of phosphatidylcholine on ultrafiltration in CAPD patients with normal ultrafiltration. A weekly measurement of the peritoneal equilibration test was conducted per patient in the hospital. A comparison between the control dialysis solution (three-week period) and the phosphatidylcholine premixed solution (three-week period) was performed on a total of 12 patients. This study shows that a phosphatidylcholine premixed dialysis solution significantly enhances ultrafiltration. Since ultrafiltration per osmotic driving force (mL/g glucose) is enhanced, the patient's glucose load per day is reduced to achieve equal ultrafiltration. In the presence of phosphatidylcholine, peritoneal permeability remained unchanged, as indicated by membrane transport characteristics. No side effects were observed.

Biological Transport↗
PubMed1989

Platelet activating factor is produced during infectious peritonitis in CAPD patients.

Peritonitis, a frequent complication of continuous ambulatory peritoneal dialysis (CAPD), is a model of inflammation which provides the opportunity to recover the exudate fluid. To date, various endogenous mediators (histamine, bradykinin, activated complement factors, prostanoids) have been implicated in the mediation of peritoneal inflammation and increased peritoneal permeability. In the present study, a lipid compound with physicochemical and biological characteristics similar to platelet activating factor (PAF) (1-0-alkyl-2-acetyl-sn-glyceryl-3-phosphorylcholine) was extracted in significant amounts from the dialysate of eight out of nine peritonitis episodes in seven CAPD patients (Group A; 6771.4 +/- 3025.9 pM, mean +/- SEM at the first exchange during peritonitis). The amounts of PAF recovered in the first exchange dialysate from patients of Group A were linearly correlated with the loss of albumin (y = -3157.64 + 91.4x; r = 0.7394; N = 9; P less than 0.03) and number of leukocytes (y = 902.45 + 1.52x; r = 0.7576 N = 9; P less than 0.02). PAF was not detectable in the dialysate fluid from patients of Group A after recovery. Twelve patients on CAPD who had no past or present history of peritonitis (Group B) were used as controls; no PAF (9 patients) or only minimal amounts (3 patients: 7.0 pM; 23.0 pM; 70.0 pM) of this mediator were detected. This is the first direct demonstration of the local generation of PAF in a septic inflammatory reaction involving the peritoneal serosa in man. PAF produced by various cell types (neutrophils, peritoneal macrophages, endothelial cells) during peritoneal inflammation may contribute to the increased permeability of the peritoneal vascular bed.

Adult↗
PubMed1989

Prospected randomized study of two Y devices in continuous ambulatory peritoneal dialysis (CAPD).

To evaluate acceptability, safety, and efficacy of a Y set with two short branches (TAS) filled with electrolytic chloroxidizer solution during the dwell time, 60 patients were randomly allocated to be treated with the traditional Y set (TCS) or with the TAS. Twenty-three were new patients whereas the remaining 37 were patients already on continuous ambulatory peritoneal dialysis (CAPD) with the TCS. The follow-up was 416.5 months in the control group and 387.4 months in the test group. During the study period there were 6 peritonitis episodes in each group with an incidence of 1 episode every 69.4 patient-months in the control group and 1 episode every 64.6 patient-months in the test group. Twenty-four patients (80%) in the control group and 27 (90%) in the test group were free from peritonitis. The probability to remain free from peritonitis was respectively 87% and 83% in the test group and in control group after 12 months, 70% and 78% after 21 months. Seventy-nine percent of the patients who used both systems preferred the TAS for better handling, lower encumbrance, and major safety. One patient preferred the TCS, three patients did not find any differences between the two devices.

Anti-Infective Agents, Local↗
PubMed1989

CAPD versus hemodialysis (HD): 7 years of experience.

The purpose of this work is to compare survival and drop-out in 2 groups of patients undergoing either CAPD (42 pts) or standard HD (48 pts) as first treatment, from November 1981 to December 1988. Mean age and number of risk factors were not significantly different. At the end of the study 50.0% of pts on CAPD and 37.5% on HD were still on first treatment; clinical problems were the most frequent cause of drop-out. The total period of observation was significantly higher in the CAPD group (1391.0 months vs 850.4), but the life table analysis showed no significant differences in the incidence of death and of drop-out in the two groups. The follow-up of the CAPD group was subdivided into two periods, due to the fact that a scheme for clinical and social survey of patients undergoing dialysis and a policy of more frequent home visits were introduced at the end of 1985. A significant decrease of peritonitis episodes was observed in the second period.

Female↗
PubMed1989

Need of a partner on home peritoneal dialysis (HPD): incidence and an alternative choice.

Among 63 patients (pts) on HPD 26 (41.7%) had need of a partner (PN) in conducting dialysis. In most cases the role of a partner is performed by the consort (26.9%) or by a son or daughter (19.3%). Forty-four percent of all partners worked in the home. The PN is significantly higher (P = 0.0001) in pts aged 65 or more. The most frequent cause of PN (38.6%) was a memory and learning deficiency (MLD) of the exact sequence of dialysis maneuvers, in particular in elderly pts. The Talking Cricket (TC), a tape recorder device with a series of automated and safety features, conceived and settled in our center to guide the patient through the dialysis procedures at home, represents a valid alternative choice to the partner in pts with MLD. Seven pts with MLD, aged between 69 and 80 years, used the TC at home with a Y-set with Amuchina. During a follow-up of 84.4 months we observed 3 peritonitis episodes, 4 accidental infusions of disinfectant in to the peritoneal cavity; and 3 pts discontinued the use of the TC. The TC has been used in the hospital to train 5 pts undergoing CAPD: standardization and uniformity of teaching facilitates both learning by the patients and teaching by the nurses.

Adolescent↗
PubMedDate not supplied

Information technology in a dialysis department.

The use of information technology in a peritoneal dialysis service, as in any facility, poses the problem of the choice of the data to be stored. It is important to define the whole range of information which may be of use and to assess the costs and benefits involved. These will depend on how complete and reliable the stored information is, how well the management process (filing and processing) is integrated with its day to day use by the Department. It is essential to both safeguard work efficiency and guarantee processing which will be useful in routine operations, including checking the quality of work carried out, and in study and research.

Computers↗
PubMedDate not supplied

[Homocysteine, folate therapy and outcome in hemodialysis: results from a prospective study].

BACKGROUND: Despite the well-known effectiveness of folate therapy on hyperhomocysteinemia in hemodialysis, its benefits on outcome are still unclear. METHODS: Sixty-five patients on thrice-weekly maintenance hemodialysis lasting more than 3 months were followed up for 1 year after stratification by predialysis homocysteine level (tHcy). Parenteral folate (25 mg quarterly) and cobalamine (1 mg quarterly) therapy was started only if the tHcy levels were > 30 uM/L at baseline or at scheduled retests (every 7 months). End points were overall mortality and new ischemic events (affecting heart, brain, or lower extremities). RESULTS: 58.5% of patients received treatment at baseline and achieved a 60% reduction of tHcy. 38.1% progressed to levels of over 30 tHcy at 6 months and were placed on treatment. No other major changes occurred until the end of the study. An excess of both overall mortality (30.8% versus 12.1%; p = 0.075) and vascular morbidity (38.5% versus 12.1%; p = 0.03) occurred in initially untreated patients,those presenting without baseline intermediate to severe hyperhomocysteinemia. CONCLUSIONS: In undertaking hemodialysis, it appears that treating intermediate to severe hyperhomocysteinemia carries better prognosis for outcome than untreated moderate or absent hyperhomocysteinemia. It is uncertain if the benefit of therapy is valid, or if it is confounded by an association between lower tHhy and hidden malnutrition or concomitant diseases.

Aged↗
PubMedDate not supplied

[Improving the outcome of peritoneal dialysis in the long term: is it possible?].

Improving the results of peritoneal dialysis (PD) over time means reducing both the technique's drop out (TDO) and mortality rates. The PD mortality rate has diminished over the years, due to greater experience in using the technique and the reduction in mortality due to peritonitis making it comparable with the hemodialysis (HD) mortality rate. Moreover, improved control of the hydrosaline balance through the use of ambulatory peritoneal dialysis (APD) and icodextrin could further improve the survival rate in the future. The adequacy targets needed to reduce the mortality rate still appear to be debatable, as their importance seems conditioned by the presence of RRF and comorbidity. The TDO is higher in PD than in HD because PD is a self-administered treatment that uses a biological membrane as a filter. The most frequent causes of TDO are peritonitis (30-40%), dialytic inadequacy (11-27%), and subsequent inability and/or choice (10-32%). Peritonitis is the cause that has seen the greatest reduction over time due to the introduction of the Y-Set, but a further reduction could result from the prevention of ESI, and from improvements in the patient selection procedure designed to identify both clinical and psycho-social disposition peritonitis risk factors. Among the causes of TDO due to dialytic inadequacy, insufficient ultrafiltration (UF) could benefit from the diffusion of APD and icodextrin, while insufficient depuration could be reduced by new targets and optimization of the prescription. Finally, TDO due to social causes could be reduced by the use of APD, care support and appropriate patient selection.

Humans↗
PubMedDate not supplied

[Evaluation of nutritional status in a group of patients undergoing CAPD].

The onset of a protein-energy malnutrition represents a real risk for patients on CAPD. In order to verify the nutritional status and the effectiveness of the dietetic surveillance in preventing this complication, dietary intake, anthropometric measurements and biochemical parameters were monitored in 46 patients (27 males, 19 females, mean age: 58.7 +/- 14.8 years), suffering from ESRF and treated with CAPD, for a total observation period of 1731.67 months (mean: 37.64 +/- 25.17 months). The mean glucose concentration in the dialysate was 2.00 +/- 0.36 g/dl, the glucose reabsorption from dialysate per kg of ideal body weight (kg-IBW) was equivalent to 5.1 kcal, the mean dialysate protein loss was 13.08 +/- 5.52 g/day and the incidence of peritonitis episodes was 1 every 30.38 months-patient. The daily total caloric intake (by mouth and dialysate) was 30.8 kcal/kg-IBW with a normal subdivision for each diet component: there were not statistically significant differences in distribution according to age, sex and in the follow-up. The mean daily value of protein intake (PI) evaluated by dietary interviews was 0.99 g/kg-IBW, with a significant increase 1 year since the beginning of CAPD; the PI evaluated from urea nitrogen appearance was 1.22 g/kg-IBW. The PI remained stable later in the follow-up and in patients that made use of dietetic supplements, the mean daily increase by this way was 0.47 g/kg-IBW. Anthropometric measurements showed a statistically significant increase of %RBW after 1 year and of TS and % body fat after 3 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

[CAPD versus hemodialysis. 7 years' experience at the Centro Dialisi in Alba].

The purpose of the study is to compare the survival of the patients and the drop-out for change of the method in 2 groups of patients (pts) undergoing either CAPD (41 pts) or standard hemodialysis (HD) (45 pts) as first treatment, since November 1981 to August 1988. Distribution per sex (24 males and 17 females in the CAPD group vs 32 males and 13 females in the HD group), mean age (61.3 years vs 56.7) and number of risk factors (57 vs 61) were not significantly different. The total period of observation was significantly higher (1305.8 months vs 780.3, P less than 0.01) and the results seemed to be better in the CAPD group, but the life table analysis showed no significant differences in the incidence of death (10 events vs 13) and of drop-out for change of the method (8 events vs 10) respectively in the CAPD and in the HD group. At the end of the study 51.2% of pts on CAPD and 33.3% on HD were still on first treatment; clinical problems (respectively 62.5% and 70.0%) were the most frequent cause of drop-out. The Authors conclude that CAPD in the medium-term is a valuable method of treatment of end-stage renal failure, competitive with standard HD when patient selection is not biased by a negative selection.

Adult↗