[Extralobar pulmonary sequestration. A case report].
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Biomedical subjects
Publications and source records attributed to M Tancredi.
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Hemodialyzed patients mean an high-risk population for hepatitis C infection. Our work was performed to evaluate the incidence of hepatitis C virus (HCV) infection in 51 hemodialyzed patients; the presence of anti-HCV antibodies was studied using the EIA and RIBA test of 1st and 2nd generation. 18 patients (35.29%) showed anti-HCV antibodies with the 1st test; 27 patients (52.94%) showed the presence of anti-HCV antibodies using 2nd generation test. The incidence of test positivity is not related to blood transfusions while it is strictly related with dialytic age. All HCV seropositive patients show antibodies against the c22-3 protein of "virus core". The presence in serum of anti-c22-3 antibodies means that in these patients, there is viral replication.
The exact pathogenesis of hepatic coma is unknown and this fact has stimulated research in the field of hemodetoxification treatment. We studied 31 patients (19 M and 12 F) with acute hepatic failure and used different detoxification techniques such as hemodialysis, hemoperfusion, hemofiltration and plasmaferesis. We evaluated blood tests, degree of coma and serum levels of middle-molecular weight substances (by gel-chromatography) for each patient. Our results show that there was an improvement of consciousness and general clinical state in 40% of patients who underwent HD, in 50% of patients treated with HP, in 37.5% of those treated with PF and 78% of patients treated with HF. Unfortunately, the improvement did not last long. In conclusion we can say that artificial support improves hepatic coma and state of consciousness. This improvement could be due to the better regeneration possibilities of hepatic cells. For this reason hemodetoxification treatment should be started as soon as possible.
Hemodialysis can remove only substances that are highly diffusable, non protein bound and with small and middle-molecular weights. The combination of Hemodialysis-Hemoperfusion (HD-HF) takes advantage of both techniques. Uremic patient could reduce the number of weekly dialysis sessions. Fourteen uremic patients were submitted twice a week to a combined HD-HP treatment for 16 months. Polymethacrylate coated charcoal was inserted in the dialysis circuit before the dialyzer. The treatment resulted in improvement of: MNCV (30.5 + -6 to 38.7 + -5.6 m/sec.) subjective symptoms (disappearance of pruritus and insomnia) and hematological status (red blood cells 3.1 x 106 to 4.02 x 106; and hematocrits 28.3 to 36.1). Good control of serum biochemistries. Creatinine and urea clearances of 228 and 236 ml/min respectively. Significant removal of middle-molecules uremic toxins determinated by gel-filtration on Sephadex G15. In conclusion, we state that combined HD-HP improves the detoxication possibilities in chronic uremia.
Thirty schizophrenic patients were treated with hemodialysis for 4-36 months. The clinical results were evaluated using two psychiatric scales: the Brief Psychiatric Rating Scale and the Inpatient Multidimensional Psychiatric Scale. In 13 schizophrenic patients psychiatric symptoms disappeared completely, and complete social reintegration followed. Eight patients showed no significant modification of schizophrenic disease after more than 30 dialysis sessions. Nine patients were not considered because their treatment was interrupted during the first month. Dialysis improved the psychotic attitude in one group of schizophrenic patients. The best results were obtained using polyacrylonitrile membranes.
The authors summarize two years trial of dialysis treatment of schizophrenia. Twenty-five schizophrenic patients were treated with hemodialysis using PAN membranes. The dialysis schedule was: dialyzer; RP 610; blood flow: 250 ml/min; dialysate flow: 500 ml/min; time: 3 hr; vascular access: arteriovenous fistula, femoral vein, antebrachial veins. Dialysis was first performed for three days, repeated after one week, two weeks, three weeks, and one month, and then performed once a month. The drug regimen was never modified or interrupted. The results were evaluated with the Overall and Lorr scale. Nine patients interrupted the treatment early and were not considered; nine patients showed disappearance of psychiatric symptomatology (Overall and Lorr index decreased to 21.8 at 2); non-significant modifications of the main schizophrenic symptoms were observed in seven patients. According to our trial, dialysis with polyacrylonitrile membranes can modify the psychotic attitude in a group of schizophrenic "dialysis responders".