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Biomedical subjects

L Gesualdo

Publications and source records attributed to L Gesualdo.

At least 73 records · Page 4Linked to original sources
PubMed1989

Efficacy and safety of cefotetan in the treatment of complicated urinary tract infections: clinical experience in a selective and single study.

A single, selective study was performed in order to evaluate the efficacy and safety of cefotetan in the treatment of complicated urinary tract infections (UTI). Of 34 pre-treatment isolated strains, 60% were pluri-resistant to other antibiotics (ampicillin, carbenicillin, piperacillin, cefalotin, aztreonam) but only 21.2% to cefotetan. Pseudomonas aeruginosa and enterococci were resistant to cefotetan. Escherichia coli was the common strain isolated (50%). Nineteen adult patients, with complicated UTI caused by sensitive organisms, were treated with a 1 g intramuscular (i.m.) daily dose. Duration of treatment ranged from 5-15 days, with a mean of 13.75 days. Within 24-48 h and 30 days post-therapy, the infection was cured in 84% and 52% of patients, respectively. Reinfection, relapse or super-infection occurred in 42% of the cases. In only one patient, the infecting organism did not respond to treatment. The clinical response was evaluated in only seven patients with symptomatic UTI. Six of them (85.7%) were cured after therapy and the cure persisted at follow-up. In most cases, the adverse reactions were local, mild and negligible. In only 15.8% and 10.5% of patients, side-effects (diarrhoea, headache, abdominal pain, tachycardia, chill, pain and erythema in the injection site) were severe and moderate. In these cases, the adverse reactions were reversible when the therapy was discontinued. The relationship between treatment and side-effects was doubtful in two cases. It is concluded that cefotetan, administered at 1 g i.m. daily dose, is effective in treating complicated UTI caused by sensitive organisms, pluri-resistant to other antibiotics.

Adult↗
PubMed1988

A multicentre study of flumequine in the treatment of urinary tract infections.

The efficacy and safety of flumequine were evaluated in the treatment of 121 cases uncomplicated (65.5%) and complicated (34.5%) urinary tract infections (UTI) when given as a dose of 400 mg bd. Duration of treatment ranged from 7-15 days, with a mean of 10. Thirty days post-therapy, cure persisted in 92.3% of the patients with uncomplicated UTI and in 53.7% of those with complicated UTI. Relapse or re-infection occurred in 34.1% of the patients with complicated UTI, and in 12.2%, the infecting organism did not respond to treatment. Flumequine was generally well tolerated. In 27.3% of patients gastrointestinal, and neurological disorders and skin rashes developed which in most cases were mild. Only two patients were withdrawn from the treatment. It is concluded that flumequine, administered at 800 mg daily, is highly effective in treating uncomplicated and complicated UTI.

Adolescent↗
PubMedDate not supplied

Vasoactive intestinal polypeptide (VIP) is not an androgen-dependent neuromediator of penile erection.

The effects of castration on vasoactive intestinal polypeptide (VIP) immunostaining in human corpus cavernosum (CC) and the relationship between VIP immunostaining and erectile function were studied in patients with localised prostate cancer who had (Group 1 = castrated) or had not (Group 2 = control) undergone 3-month neoadjuvant chemical castration before radical prostatectomy. Evaluation of erectile function included medical and sexual history, physical examination, and measurement of total serum testosterone. CC biopsies were taken at the end of radical prostatectomy and samples immunostained with anti-human VIP antibody. Specific staining was quantified by image analysis and expressed in arbitrary units (AU). Chemical castration induced erectile function deterioration in 70% of patients due to loss of sexual interest and confidence in the ability of having an erection rather than reduced ability of obtaining sexually induced erections. Average VIP content was 34.5 AU in Group 1 and 39 AU in Group 2 and this difference was not statistically significant. Chemical castration does not influence VIP immunostaining of human CC, suggesting that VIP is not an androgen-dependent neuromediator of penile erection and that it can be responsible for sexually induced erections in castrated patients.

Aged↗
PubMedDate not supplied

Thrombin: a novel renal growth factor.

Glomerular fibrin deposition is a common histopathological finding in a variety of glomerular diseases and suggests the intraglomerular activation of the coagulation system. The activation of thrombin is the last step in the coagulation cascade. On the basis of its ability to modulate several cell functions through the activation of different receptors and intracellular-signaling pathways, thrombin could be considered as a growth factor more than as a simple coagulation factor. Indeed, this multifunctional serine protease may represent the link between the activation of the coagulation cascade and the inflammatory and profibrotic response at the glomerular level. This review will focus on the potential role of thrombin in the pathogenesis of glomerular damage and on the mechanisms underlying the cellular effects of this serine protease.

Animals↗
PubMedDate not supplied

Ramipril inhibits in vitro human mesangial cell proliferation and platelet-derived growth factor expression.

Angiotensin-converting enzyme (ACE) inhibitors are antihypertensive drugs that have been shown to reduce proteinuria and to slow down the progression of renal function deterioration in different models of chronic glomerular disease. Major pathogenetic features of progressive glomerular injury leading to glomerulosclerosis are mesangial cell proliferation and platelet-derived growth factor (PDGF) expression. The aim of the present study was to evaluate the effect of ramipril, an ACE inhibitor, on these two potential therapeutic targets. Thus, the effect of ramipril on DNA synthesis, cell proliferation and PDGF A and B chain gene expression in fetal calf serum (FCS)-activated cultured human glomerular mesangial cells was investigated. DNA synthesis was evaluated by tritiated thymidine incorporation, cell proliferation by direct cell counting and cell viability by 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide (MTT). PDGF A and B chain gene expressions were studied by Northern blot and RT-PCR, respectively. In a dose-dependent manner ramipril inhibited the FCS-induced DNA synthesis and cell proliferation. This effect was not dependent upon a toxic effect as demonstrated by MTT. The antiproliferative effect of ramipril was most likely independent of its ability to inhibit ACE present in the FCS and/or expressed by the cells, since a synthetic peptide that specifically inhibits ACE, at the same molar concentrations, did not inhibit FCS-stimulated DNA synthesis. Moreover, ramipril significantly reduced FCS-induced PDGF A and B chain gene expression. Finally, ramipril completely abolished the PDGF A and B chain gene expression induced by phorbol 12-myristate 13-acetate, a specific protein kinase C activator, suggesting a site of action downstream of this enzyme in the mitogenic signal transduction pathway. Our study would suggest that the modulatory action of ramipril on activated mesangial cell proliferation and PDGF expression is independent of its ability to inhibit ACE and could represent an additional mechanism in the renal protective effects of this drug.

Angiotensin-Converting Enzyme Inhibitors↗
PubMedDate not supplied

Prospective randomized controlled multicenter trial on steroids plus ramipril in proteinuric IgA nephropathy.

Recent studies have shown that steroids improve renal survival and reduce proteinuria in IgA nephropathy (IgAN) patients with moderate urinary protein excretion and normal renal function. However, this effect seems to diminish over time. Moreover, it has been demonstrated that long-term use of ramipril reduces the risk of end-stage renal disease in proteinuric diabetic and non-diabetic chronic nephropathies. We have planned a long-term unblinded, prospective, centrally randomized, controlled, multicentric trial to assess whether combined treatment of steroids and ramipril is superior to ramipril alone in patients with progressive IgAN disease. A minimum of 134 patients with biopsy-proven IgAN, grade G3 or G4, daily proteinuria > 1.0 g and creatinine clearance > 50 mL/min will be enrolled during a 2-year recruitment period. The patients will be allocated randomly to receive a six-month course of oral prednisone (1.0 mg/Kg/day for 2 months, tapered by 0.2 mg/Kg/day every month) plus ramipril (2.5 mg/day for one month, increased by 1.25 mg/day every month to achieve and maintain a blood pressure less than 120-80 mm Hg and/or to reduce daily proteinuria to 1.0 g or less or by at least 50%) in the experimental group or ramipril alone in the control group. Ramipril will be administered during the whole 5-year follow-up period in both groups. The primary endpoint will be renal survival estimated by 50% increase in baseline serum creatinine; the secondary endpoints will be urinary protein and cytokine excretion and side-effects. Analyses will be done by intention to treat. A p <0.05 will be taken as significant.

Angiotensin-Converting Enzyme Inhibitors↗
PubMedDate not supplied

The role of alpha-smooth muscle actin and platelet-derived growth factor-beta receptor in the progression of renal damage in human IgA nephropathy.

BACKGROUND: The degree of tubulointerstitial damage can be considered a better indicator of renal function outcome in IgA nephropathy (N) than the extent of glomerular sclerosis. MATERIALS AND METHODS: To investigate the pathogenetic mechanisms of interstitial injury in IgAN, we used immunohistochemistry and in situ hybridization to evaluate the glomerular and tubolointerstitial expression of PDGF-beta receptor (R) and alpha-smooth muscle actin (SMA), two markers of mesenchymal cell activation, and correlated these findings with the histopathologic and clinical features of the disease. We studied 155 IgAN patients, divided into three groups based on the histological findings (mild, moderate and severe histological lesions). RESULTS: In normal kidneys and in patients with mild histological lesions, the interstitial areas showed scattered peritubular cells positive for PDGF-betaR and alpha-SMA, with a distribution resembling the capillary network. In the glomeruli several cells (mainly in the mesangial area) stained for PDGF-betaR, but only very few cells were positive for alpha-SMA. Alpha-SMA and PDGF-betaR staining, as expected, was also observed in vascular smooth muscle cells. Compared to patients with mild histological lesions, alpha-SMA expression was strikingly increased in patients with moderate to severe lesions, particularly in areas of tubulointerstitial fibrosis. In these patients, PDGF-betaR gene and protein expression, at the tubulointerstitial level, paralleled that in alpha-SMA. Both signals were significantly correlated with the interstitial damage (interstitial infiltrate and fibrosis). Interestingly, these patients showed a different pattern of distribution of alpha-SMA and PDGF-betaR in the glomeruli: PDGF-betaR expression was upregulated, whereas no changes were seen in alpha-SMA staining. In addition, glomerular PDGF-betaR staining was significantly correlated with mesangial cell proliferation, while alpha-SMA was not. Image analysis showed that 40.2+/-10.3/1,000 microm2 of interstitial cells were positive to both PDGF-betaR and alpha-SMA, but only 2.8+/-1.8/1,000 microm of glomerular cells expressed both signals. CONCLUSIONS: Our study supports the hypothesis that interstitial PDGF-betaR and alpha-SMA positive cells may play a key role in the pathogenesis of tubulointerstitial damage.

Actins↗
PubMedDate not supplied

Epidemiology of primary glomerulonephritis in the elderly. Report from the Italian Registry of Renal Biopsy.

BACKGROUND: In the pre-biopsy era, primary glomerulonephritis (GN) was thought to pertain to children and adults. On the contrary, as renal biopsy came into clinical practice, this disease was recognized to affect the elderly too, even if the rate of such an occurrence still had to be defined. Recently, the Italian Registry of Renal Biopsy provided the opportunity to ascertain the diffusion of elderly GN in epidemiological terms. METHODS: Eighty-eight per cent of the Italian Renal Units known to routinely perform renal biopsy reported the records of patients who underwent biopsy investigation in 1996. Thus, 2,511 cases were ranked according to patient's age, histological diagnosis and clinical manifestation. The age-related incidence of each clinicopathological picture was calculated as the ratio between the number of patients found to be affected during the year and the number of subjects at risk, namely all age-matched people living in Italy in the same year. RESULTS: A diagnosis of primary GN was found in 1,474 records. Elderly patients accounted for 19% of those biopsy-proven primary GN, though elderly people were only 16% of the Italian population. This disproportion indicated that the incidence of primary GN in the elderly was higher than expected: actually, when compared to the incidence in the adult, it was 30.8 vs. 28.3 cases per million of population (PMP). Four histological pictures were found to be more frequent in the elderly than in the adult: membranous GN (13.4 vs. 4.2 PMP), crescentic GN (3.1 vs. 0.9 PMP), membranoproliferative GN (2.9 vs. 0.4 PMP), acute post-streptococcal GN (0.9 vs. 0.4 PMP). As for clinical manifestations, all GN-related symptoms were more frequent in the elderly than in the adult, except one: urinary abnormalities (4.5 vs.14.1 PMP). CONCLUSION: Through the Italian Registry of Renal Biopsy, primary GN was found to occur more frequently in the elderly than in the adult. Such a high incidence would be even higher if aged patients showing urinary abnormalities regularly underwent renal biopsy. As this result reverses all previous views, many issues about elderly GN should be reconsidered.

Adolescent↗
PubMedDate not supplied

[Evaluation of quality of life by improving the uraemic anaemia status].

BACKGROUND: Anaemia is one of the most common signs of chronic uraemia that determines an increase in both morbidity and mortality, as well as a deterioration in the quality of life of affected patients. We evaluated the impact of the application of the European Best Practice Anaemia Guidelines to the quality of life of dialysed patients. PATIENTS AND METHODS: We studied for 12 months (from December 2000 to November 2001) 62 patients in haemodialysis and 22 patients in peritoneal dialysis. For the statistical analysis the following parameters were examined: haemoglobin levels, TSAT, and weekly doses of Epo. To assess the quality of life we asked the patients, at the initial visit and 12 months after treatment, to fill out the "Medical Outcome Study Short Form 36 items Heath Survey" and "Kidney Disease Quality of Life". RESULTS: The significant increase in TSAT levels attained in haemodialysed patients (p = 0.03) induced an increase in haemoglobin levels and consequent reduction in EPO administration (p = 0.04). During the study, a significant improvement in General Health (GH) (p = 0.03) was observed. At the end of the treatment, Physical Functioning (PF) (p = 0.04), Role and Physical Health (RP) (p = 0.02) and Social Functioning (SF) (p = 0.005) showed significant variations. CONCLUSIONS: The application of the European Best Practice Anaemia Guidelines improves the management of anaemia and the Global Health Assessment in uraemic patients. These data demonstrate how inappropriate anaemia management can negatively affect the quality of life of these patients and increase the medical costs.

Aged↗
PubMedDate not supplied

[Nutcracker syndrome: a difficult case of recurrent gross hematuria].

BACKGROUND: The Nutcracker Syndrome (NS) is an uncommon clinical condition caused by compression and entrapment of the renal vein (LRV) as it passes through the angle between the superior mesenteric artery (SMA) and the aorta (meso-aortic angle). Intermittent macrohematuria, left peripelvic and gonadal vein varices and aspecific abdominal pain may be common manifestations of this syndrome. CASE-REPORT: A 15-year-old white boy developed recurrent macrohaematuria in June 2002. He had a history of upper respiratory infection prior the first episode of gross hematuria followed by 4 other episodes of macrohematuria 'sine causa'. Blood pressure and renal function were normal. Routine laboratory tests showed only an increase in serum LDH levels (901 IU/L) with negative Coombs' test, both direct and indirect, and absence of schistocytes in the blood smear. Renal ultrasonography showed normal kidneys while an intravenous pyelography showed a 'minus' in the right ureter. For this reason, a cystoscopy and a retrograde pielography were performed but resulted normal. A renal biopsy was carried out because of the presence of one episode of post-infective macrohaematuria, but light microscopy and immunofluorescence examinations were found to be normal. Renal ultrasonography and Color Doppler ultrasonography (CD-USG) oriented our diagnosis towards NS. An abdominal computerised tomography (CT) scan confirmed that the LRV was compressed between the aorta and the SMA. CONCLUSIONS: NS cannot be diagnosed with routine diagnostic methods. Endoscopic and radiological methods may provide some clues for the presence of NS, while CD-USG may be considered to be the first level non-invasive method for diagnosis. The sensitivity and specificity of this test for diagnosing NS is reported as being 78% and 94%, respectively. The best treatment available for this syndrome is still being debated.

Adolescent↗
PubMedDate not supplied

[Cardiovascular risk and renal transplantation].

Cardiovascular disease after renal transplantation is often the expression of a disease process that first started with the onset of renal dysfunction many years before, and its prevention starts with the early predialysis phase of chronic renal failure and with the aggressive treatment of hypertension and dyslipidemia. The evidence that dialysis treatment itself accelerates arterial damage is poor. After transplantation, however, many patients are restored to a state not of normal renal function but of chronic renal impairment and have drug-induced hypertension and dyslipidemia, resulting in a vastly increased risk of atherosclerosis. Further research is required on optimal strategies to prevent or ameliorate cardiovascular disease, to establish the roles of lipid-lowering and antihypertensive therapies after transplantation and to define immunosuppressive ad hoc treatments for each kind of patient.

Cardiovascular Diseases↗
PubMedDate not supplied

[Renal neoplasms and renal transplantation: current problems and future perspectives].

Primary carcinomas of the kidney can develop in renal transplantation in four sets of circumstances: (1) detected in the donor, (2) detected as a pre-existing neoplasm in the recipient prior to transplantation, (3) as de novo malignancies arising post-transplantation in the native kidneys of the recipient, (4) or in the graft. In Italy, any renal mass detected during harvesting does not allow the use of any organs for transplantation; however, several reports from other countries have already shown the safety and efficacy of transplanting kidneys with small (<4 cm), unifocal, subcapsular tumors, after resecting the lesion at the back table and verifying the negativity of the surgical margins; this strategy could also be evaluated in Italy to expand the donor pool. Acquired cystic kidney disease (ACKD) is commonly observed in uremic patients undergoing chronic hemodialysis (HD); numerous studies have reported an increased prevalence of renal cell carcinoma (RCC) in association with this nephropathy. The use of ultrasound, computerized axial tomography (CAT) and magnetic resonance imaging (MRI) has greatly improved the ability to detect renal tumors at earlier stages associated with ACKD and the morbidity and mortality rate, in either uremic or transplant patients. RCC in the transplanted kidney is rare and, when recognized, requires nephrectomy. However, a conservative approach with nephron sparing surgery has been reported for selected cases as a useful strategy to treat renal carcinoma in the allograft.

Carcinoma, Renal Cell↗
PubMedDate not supplied

[Italian Registry of Dialysis and Transplantation: 1996-2001 experience].

The Italian Registry of Dialysis and Transplantation (RIDT) was born in 1996 under the aegis of the Italian Society of Nephrology, and it is organized as a federation of regional registries. This study aimed to completely revise the epidemiological data collected during the first 5 yrs (1996-2001) of RIDT activity to evaluate the trends of the main epidemiological features. During this period, regional registries were not always able to assure complete and exhaustive information according to RIDT requirements, owing to different levels of organization and functioning. To avoid any possible error in data analysis, information inadequately assessed was refused. The incidence of end-stage renal disease (ESRD) patients on renal replacement therapy (RRT) in Italy has increased from 114 pmp in 1996 to 139 pmp in 2001, that means an increase of 3.5%/yr, corresponding to 5718 patients during 1996 and 8000 patients during 2001. Primary renal diseases (according to the EDTA) in incident ESRD patients are vascular and diabetic nephropathy. Main dialysis modality in incident patients was hemodialysis (HD) (85%), while peritoneal dialysis (PD) was only 15%; pre-emptive transplantation was a very unusual modality. The prevalence of ESRD patients at 31 December was 693 pmp in 1996 and 827 pmp in 2001; among dialysis patients, the corresponding rates were 575 pmp and 657 pmp, respectively. Consequently, the number of dialyzed patients increased, respectively, from 28892 to 37919. The prevalent dialysis modality was bicarbonate dialysis in 74% of cases, followed by hemodiafiltration (HDF) in 15%, continuous ambulatory peritoneal dialysis (CAPD) in 7% and APD in 3%. The gross mortality rate in dialyzed patients was stable during this period, at approximately 14%, the main causes of death being cardiovascular diseases and cachexia.

Adolescent↗
PubMedDate not supplied

[Acute biocompatibility of hemodiafiltration with endogenous reinfusion (HFR)].

PURPOSE: In order to reduce the hemodialysis (HD)-induced pro-inflammatory activity we need to use a biocompatible dialysis membrane, avoid backfiltration and possibly use adsorbents. Hemodiafiltration reinfusion (HFR) is a new on-line hemodiafiltration (HDF) technique combining these aspects. This study aimed to evaluate the biocompatibility of the single dialysis session comparing standard HD and HFR. METHODS: Eighteen patients on chronic HD were enrolled in five Centers. Patients underwent one standard and two HFR study sessions; in each session we evaluated leukocyte activation at 0, 5, 15, 60 and 240 min; and interleukin-6 (IL-6), C-reactive protein (CRP) and IL-1 receptor antagonist (IL-1Ra) levels at 0, 60 and 240 min. RESULTS: Leukocyte activation was similar in HD and HFR, while the post-dialysis IL-6 increase was lower with HFR; CRP levels were stable during HFR, but increased after HD, and IL-1Ra did not demonstrate any difference. CONCLUSIONS: These preliminary data show that HFR still has a better biocompatibility in the single dialysis session.

Hemodiafiltration↗
PubMedDate not supplied

[Immunosuppressive drugs and renal transplantation].

Although the use of new immunosuppressive drugs, and their combination have drastically reduced the incidence of acute rejections, the graft survival is unchanged in the last ten years. The immunosuppressive drugs can be divided in four classes, according to their different site of molecular action: proliferative signal inhibitors, amplification signal inhibitors; STATs inhibitors, DNA synthesis inhibitors. Steroids act on immune system through several mechanisms. Azathioprine is an anti-metabolite that inhibits de-novo synthesis of purins, acting on S-phase of cellular cycle. Mycophenolate-Mofetil (MMF) is also an anti-metabolite, purine synthesis inhibitor that, differently from azathioprine, acts specifically on IMPDH (Inositolmonophosphate-dehydrogenasis) through a non-competitive mechanism. Calcineurin inhibitors (cyclosporin and tacrolimus) act on amplification of intracellular signal. The most important therapeutic side-effect of calcineurin inhibitors is the nephrotoxicity. Other inhibitor agents of the amplification signal are monoclonal antibodies anti-á chain of IL-2 (CD25). Another drug used in the last years, is sirolimus (SRL) or rapamycine, an immunosuppressive agent that act, through the inhibition of T lymphocyte activation.

Graft Rejection↗