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L Poli

Publications and source records attributed to L Poli.

103 records · Page 6Linked to original sources
PubMedDate not supplied

Immunoadsorption with protein A in humoral rejection of kidney transplants.

The presence of alloantibodies may play a role in accelerated or acute humoral rejection. Different therapeutic strategies based on a removal of anti donor antibodies and prevention of their resynthesis have been used in the management of transplant rejection episodes. Immunoadsorption with staphylococcal protein A, a method to selectively remove immunoglobulin G, may represent a new treatment to reverse humoral rejection in kidney transplantation. From 1991 to January 1996, such a method was used in 23 patients in whom an acute humoral rejection developed over a mean period of 14.1 +/- 9.5 days after operation. Twenty-two patients had been transplanted from living donors and one from a cadaveric donor. The ages ranged from 23 to 58 years (mean, 34 +/- 10 years). All transplants were performed according to a negative direct crossmatch. Basic immunosuppression included cyclosporine, steroids, azathioprine, and antilymphocyte globulin or monoclonal antibodies (OKT3). Rejection was diagnosed on the basis of hematochemical tests, Doppler ultrasonography, and kidney biopsy. Only steroid and monoclonal and polyclonal antibody resistant rejections with > 165% positive direct crossmatches against the donor were treated with Protein A immunoabsorption. The procedure used is based on the treatment of 2-3 plasma volumes for the first 2 days and then every other day until a negative crossmatch is obtained, together with improvement in clinical status (mean treatments, 7.3 +/- 4.5 [range, 4-23]; mean duration of treatment, 12.3 +/- 10.2 days [range, 3-44]). From the start of treatment, azathioprine is replaced by cyclophosphamide at a dose of 1-2 mg/kg/day. During treatment, a remarkable fall in immunoglobulin G levels is achieved on the first day, whereas immunoglobulin M titers remain constant, with a slight decrease in serum albumin. Immediately after treatment, a negative crossmatch was found in 22 (95.6%) of 23 patients. In six patients (26%), graft function did not recover, and one patient (4.3%) died. Preliminary results show that immunoabsorption with staphylococcal protein A may be an effective support in the treatment of humoral acute rejection, particularly when it is performed as soon as an early diagnosis of humoral rejection is made. In fact, such treatment has a highly selective adsorption, allows treatment of large volumes of plasma, and can achieve a rapid decrease in the titer of circulating immunoglobulins.

Acute Disease↗
PubMedDate not supplied

Age-related transcranial Doppler findings in the evaluation of cerebral circulation during postprandial and postural tests.

We used transcranial Doppler (TCD) to investigate whether there are cerebral circulation differences between young and elderly subjects in response to postprandial postural changes. Preprandial and postprandial systolic and diastolic blood pressure, heart rate, mean middle cerebral artery (MCA) velocity (Vmean MCA), systolic/diastolic MCA velocity ratio (Vs/Vd MCA) and pulsatility index (PI) were determined in 15 healthy elderly subjects (mean age 74.3 +/- 6.5 years) and in 10 younger subjects (mean age 31.6 +/- 7. 2 years) in the supine position and after a postural change. As compared with young subjects, elderly ones showed a greater postprandial systolic pressure decline (p < 0.05) associated with a significant decrease of Vmean MCA (p < 0.05), and a greater increase of Vs/Vd and PI (p < 0.05 both). We conclude that, as compared with young subjects, elderly ones have reduced cerebrovascular adaptive response to pressure modifications induced by postprandial postural changes.

Adult↗
PubMedDate not supplied

[The evolution of immunosuppression in clinical kidney transplantation: the experience of 700 cases].

Kidney transplantation was first introduced in Italy in 1966 by the II Surgical Pathology of the University of Rome giving a great contribution to the development of the transplant surgery in this country. The authors report their 25-year experience analyzing the results obtained in more than 700 kidney allografts. A progressive refinement in the surgical transplant technique both from cadaver and live as well as clinical trials on new immunosuppressive protocols characterized their work.

Actuarial Analysis↗
PubMedDate not supplied

Immunological studies of renal allograft recipients treated with total lymphoid irradiation.

It is well known that highly sensitized patients and/or high responders, even under CsA therapy, constitute a risk category for transplantation. Based on this evidence, in 1982, our group initiates a pilot study using total lymphoid irradiation (TLI) as a pre-transplant modulator of patient's immuno-response. TLI has been employed in 30 uremic, non diabetic, patients. During this experience the first protocol, characterized by pre-transplant TLI greater than 2,000 rads (13 pts.) and post-transplant conventional therapy, was abandoned because of the severe TLI side effects. In the second protocol TLI dose never exceeded 2,000 rads and CsA was given, at initial dose of 7-12 mg/Kg/day according to CsA blood through levels. The immunological monitoring was performed during TLI treatment and in the postoperative clinical course by cell markers profile determination and functional assays. The data obtained have demonstrated that TLI treatment causes a prolonged depression in CD4 positive cells, a predominant recovery of T suppressor population, a pronounced impairment of T functions and a development of specific unresponsiveness to donor antigens. Furthermore the TLI plus CsA protocol, showing an additive effect which steadily decreases patient immunoreactivity, a lack of side effects and a stable long term graft function seems to be a more useful method for transplantation in high-risk or in strongly immunoreactive patients.

Antilymphocyte Serum↗
PubMedDate not supplied

[Evaluation of pre- and postoperative cerebral hemodynamics in extracranial carotid surgery using transcranial Doppler. Preliminary note].

The Authors report their preliminary experiences concerning the use of transcranial Doppler (TCD) in the pre- and postoperative monitoring of extracranial carotid surgery. TCD is a non invasive method of investigation able to give informations about the distribution of cerebral blood flow and about the mechanisms of compensation of Willis' circle. Furthermore, TCD showed itself to be very useful in the postoperative qualitative evaluation of surgery, pointing out, as a general rule, an increased flow in the middle cerebral artery after thromboendarterectomy of internal carotid artery. This haemodynamic modification, if present, is perceptible since the immediate postoperative period and becomes more evident and definitely stable at a distance of 20-30 days after operation, likewise the definitive stabilization of Willis' circle's haemodynamics.

Aged↗
PubMedDate not supplied

[Sedation with flunitrazepam during spinal anesthesia].

The clinical effects of flunitrazepam (FNZ) as IV sedative agent for spinal anaesthesia was studied. Of 112 elderly patients undergoing hip surgery, 40.2% have required a total dose of 26.6 +/- 2.3 mcg X kg-1. The repeat doses were 9.3 to 13.3 mcg X kg-1. A good state of sedation was obtained in 81% of patients, with a linear relationship between narcosis states and FNZ's doses. In 93% of cases, FNZ was provided peroperative amnesia without post-operative somnolence. No clinically adverse cardiovascular effects were encountered. There was a small, but statistically significant increase in arterial carbon dioxide tension. In summary, FNZ provided useful sedation.

Aged↗
PubMedDate not supplied

[Homozygotic drépanocytemia (author's transl)].

A clinical description according to four age groups: before 5 with hand and foot syndrome, hemolytic chronic and sometimes acute anemia; after 5 with frequent surgical-like abdominal syndromes and development troubles; after puberty with patent dystrophia and anemia; adult age group of rare surviving patients. The drepanocytic condition is aggravated by various infections and reversly facilitate lung infections and osteitis caused by staphylococci or salmonellae. Malaria trophozoïte is suspected of inducing sickling which gives way to a rapid phagocytosis of both sickle cell and Plasmodium.

Adolescent↗