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Biomedical subjects

M V Rocco

Publications and source records attributed to M V Rocco.

At least 37 records · Page 2Linked to original sources
PubMed1997

Report from the 1995 Core Indicators for Peritoneal Dialysis Study Group.

The 1995 Peritoneal Dialysis Core Indicators Study was conducted by the Health Care Financing Administration to ascertain standard practices and outcomes in chronic peritoneal dialysis patients. Data from 1,202 patients who did not receive hemodialysis but who were on chronic ambulatory peritoneal dialysis (CAPD) for at least part of the 6-month period between November 1, 1994, and April 30, 1995, are reported. The mean serum albumin level for this cohort was 3.5 g/dL by the bromcresol green method and 3.2 g/dL by the bromcresol purple method. Data sufficient to calculate a weekly Kt/V(urea) or weekly creatinine clearance were available for only 34% of patient submissions. In these patients, the median weekly Kt/V(urea) was 1.7 using a fixed value for V of 0.58 x body weight and was 2.0 using the Watson equation to calculate V; the median weekly creatinine clearance was 60.7 L/wk/1.73 m2. The mean hematocrit for this cohort was 32% and the average weekly recombinant human erythropoietin (rHmEPO) dose was 115 u/kg. Hematocrit values < or = 30% were found in 50% of black patients and 31% of white patients. The average blood pressure among peritoneal dialysis patients was 139/80 mm Hg, with 29% of patients having a systolic blood pressure exceeding 150 mm Hg and 18% a diastolic blood pressure greater than 90 mm Hg. In summary, serum albumin levels were significantly lower in peritoneal dialysis patients than in hemodialysis patients. Approximately one third of peritoneal dialysis patients did not have an adequacy measure obtained during the 6-month observation period. A significant minority of patients had either inadequately treated anemia of chronic renal disease or hypertension. There is an opportunity to substantially improve the medical care provided to chronic peritoneal dialysis patients.

Adolescent↗
PubMed1997

Cross-sectional study of quality of life and symptoms in chronic renal disease patients: the Modification of Diet in Renal Disease Study.

The purposes of this study were to measure health-related quality of life in the Modification of Diet in Renal Disease clinical trial; correlate quality of life measures with demographic, medical, and laboratory variables; and compare quality of life in various chronic diseases. The 1,284 patients enrolled in the baseline period of the Modification of Diet in Renal Disease study who completed at least one measurement of quality of life or symptoms served as the subjects of this study. The Quality of Well-Being (QWB) scale, which was a general health-related quality of life index, the Symptom Checklist-90R (SCL-90R), which provided a global measure of mental health, and the Patient Symptom Form, which assessed the frequency of symptoms specific to this population, were used as measurements. The mean +/- SD QWB score was 0.74 +/- 0.09. Using multivariate analysis, there was a significant negative correlation between the overall QWB score and age and female gender, and a significant positive correlation between the QWB and level of education, income, and glomerular filtration rate (GFR). For the SCL-90R subscores, the mean normalized Global Symptom Index was 49.7 +/- 9.6, the Positive Symptom Total was 47.9 +/- 10.4, and the mean Positive Symptom Distress Index was 51.3 +/- 12.6. Using multivariate analysis, significant inverse relationships were seen between each of the SCL-90R subscores and income, serum albumin level, and GFR. The most commonly reported medical symptoms in this cohort included tiring easily, weakness, lack of pep or energy, difficulty sleeping, and abdominal bloating or gas. Symptoms in which the severity index score had a negative correlation with GFR included tiring easily, weakness, lack of pep and energy, muscle cramps, easy bruising or bleeding, bad taste in mouth, and hiccoughs. In conclusions, patients with moderate to advanced renal insufficiency have a reduced quality of life and an increased frequency and severity of both symptoms and psychological distress, with the magnitude of these changes negatively correlated with GFR.

Chronic Disease↗
PubMed1997

Quantification of hemodialysis: analysis of methods and the relevance to patient outcome.

Quantification of small solute removal in patients treated with chronic hemodialysis (HD) is widely used to assessed the adequacy of both prescribed and delivered treatment. Four recent American studies have demonstrated a clear relationship between delivered dialysis dose and outcome in chronic HD patients. Although a number of HD quantification methods have been proposed, no specific technique is accepted as the gold standard at present. The primary goal of this review is to provide a critical assessment of the four recently published studies relating to HD outcome to dialysis dose. As these studies involved a variety of therapy quantification methods, a review of the most common techniques used to measure dialysis dose is also presented. In addition, two unresolved issues that have recently come to the forefront of HD quantification are presented. These issues are the role of dialysate-side measurement of HD dose and the potential limit of the beneficial effect of increasing HD dose on clinical outcome. Finally, the overall design of the NIH HD adequacy trial is discussed, with particular attention paid to the kinetic methods used in the study.

Humans↗
PubMed1996

Final outcome results of the Multicenter Isradipine Diuretic Atherosclerosis Study (MIDAS). A randomized controlled trial.

OBJECTIVE: To compare the rate of progression of mean maximum intimal-medial thickness (IMT) in carotid arteries, using quantitative B-mode ultrasound imaging, during antihypertensive therapy with isradipine vs hydrochlorothiazide. DESIGN: Randomized, double-blind, positive-controlled trial. SETTING: Nine medical center clinics. POPULATION: A total of 883 patients with baseline mean +/- SD systolic and diastolic blood pressure (SBP and DBP, respectively) of 149.7 +/- 16.6 and 96.5 +/- 5.1 mm Hg, age of 58.5 +/- 8.5 years, and maximum IMT of 1.17 +/- 0.20 mm. INTERVENTIONS: Twice daily doses of isradipine (2.5-5.0 mg) or hydrochlorothiazide (12.5-25 mg). MAIN OUTCOME MEASURE (PRIMARY END POINT): Rate of progression of mean maximum IMT in 12 carotid focal points over 3 years. RESULTS: There was no difference in the rate of progression of mean maximum IMT between isradipine and hydrochlorothiazide over 3 years (P=.68). There was a higher incidence of major vascular events (eg, myocardial infarction, stroke, congestive heart failure, angina, and sudden death) in isradipine (n=25; 5.65%) vs hydrochlorothiazide (n=14; 3.17%) (P=.07), and a significant increase in nonmajor vascular events and procedures (eg, transient ischemic attack, dysrhythmia, aortic valve replacement, and femoral popliteal bypass graft) in isradipine (n=40; 9.05%) vs hydrochlorothiazide (n=23; 5.22%) (P=.02). At 6 months, mean DBP decreased by 13.0 mm Hg in both groups, and mean SBP decreased by 19.5 mm Hg in hydrochlorothiazide and 16.0 mm Hg in isradipine (P=.002); the difference in SBP between the 2 groups persisted throughout the study but did not explain the increased incidence of vascular events in patients treated with isradipine. CONCLUSION: The rate of progression of mean maximum IMT in carotid arteries, the surrogate end point in this study, did not differ between the 2 treatment groups. The increased incidence of vascular events in patients receiving isradipine compared with hydrochlorothiazide is of concern and should be studied further.

Aged↗
PubMed1996

Capillary electrophoresis for the determination of glomerular filtration rate using nonradioactive iohexol.

High-performance liquid chromatography (HPLC) has been used as an alternative to the isotopic method to calculate glomerular filtration rate (GFR). With the HPLC method, serum iohexol or iothalamate levels are measured, and the plasma clearance rate of the compound is used as a surrogate for GFR. However, HPLC is a labor-intensive procedure, which limits its usefulness in the clinical setting. Capillary electrophoresis, a newer technique in which electrophoretic separations are performed in capillary tubes, is easier and faster than HPLC. We used capillary electrophoresis for the determination of serum iohexol levels and the calculation of GFR. Patients underwent a simultaneous 125I-iothalamate clearance test and a plasma iohexol clearance test to determine GFR. Mean GFR (+/-SD) was 70.9 +/- 29.9 mL/min (range, 14.5 to 131 mL/min) in 52 patients as determined by standard iothalamate clearance methods. For iohexol clearance, the correlation coefficient and standard error were 0.93 and 10.9 mL/min, respectively, using capillary electrophoresis compared with the iothalamate method. Capillary electrophoresis is a simple, rapid method that can be used to calculate GFR and provides results at least as accurate as those obtained by HPLC and x-ray fluorescence.

Adult↗
PubMed1996

Utilization of inpatient and outpatient resources for the management of hemodialysis access complications.

Complications of hemodialysis accesses are a major cause of morbidity in chronic hemodialysis patients. Although several investigators have reported on the utilization of inpatient services for hemodialysis access complications, there is a paucity of data regarding the utilization of outpatient services and temporary accesses for these complications. In this retrospective study, we identified all access-related inpatient admissions and outpatient encounters and procedures performed in an incident cohort of hemodialysis patients. Eighty-eight patients were followed for an average of 487.4 +/- 316.9 days, for a total of 119.1 patient-years of risk. The mean age was 57.0 +/- 14.6 years, with 55% females and 65% blacks; 31% of patients had diabetes mellitus as the primary cause of end-stage renal disease. Patients were referred to our nephrology practice a median of 56 days prior to the placement of a hemodialysis access and a median of 76 days prior to the initiation of hemodialysis. At the initiation of hemodialysis, 48 native arteriovenous fistulas and 40 polytetrafluoroethylene grafts were placed. Only 28 patients (31.8%) had a permanent access placed at least 14 days before the start of hemodialysis, resulting in the placement of 93 temporary accesses during the first week of dialysis therapy. Because of access complications, 21 patients had failure of their primary access, requiring the placement of 33 additional permanent accesses, including six native arteriovenous fistulas, 23 polytetrafluoroethylene grafts, and four permacaths, or an average of 0.28 new accesses per patient-year of risk. During the study period, 45 patients (51%) had at least one access complication. To manage these access complications, 25 fistulograms (0.21 per patient-year of risk) were performed and 116 additional temporary accesses (0.97 per patient-year of risk) were placed, including 50 femoral (43.1%), 52 subclavian (44.8%), and 14 internal jugular (12.1%) catheters. A total of 2.43 inpatient days and 1.05 outpatient encounters per year of patient risk were directly attributed to admissions solely for access complications. There is significant utilization of outpatient services, temporary accesses, and fistulograms in the management of hemodialysis access complications. These services should be included whenever a review of hemodialysis access procedures or costs are undertaken.

Adult↗
PubMed1996

Measurement of glomerular filtration rate using nonradioactive Iohexol: comparison of two one-compartment models.

Radioisotopic methods for the determination of the glomerular filtration rate (GFR) are highly accurate but require the collection of multiple blood and urine samples and are costly to perform due to personnel, material, and analysis costs. Nonradioactive methods of GFR determination have the potential of minimizing procedure costs while preserving accuracy. We determined the GFR simultaneously by 125I-iothalamate and nonradioactive iohexol clearance methods in 41 adults. The study group consisted of 54% males, with a mean age of 50.7 (range 28-79) years and a mean GFR by 125I-iothalamate clearance of 66.5 +/- 28.3 (range 10-118) ml/min. The iohexol concentrations were measured by a simplified high-performance liquid chromatography method that did not require sample preparation. The iohexol plasma clearance was calculated by both a new one-compartment model as well as by Jacobsson's one-compartment model. Using Jacobsson's single-sample model and data from the 240-min point, there was an excellent correlation between 125 I-iothalamate and nonradioactive iohexol clearance values: r2 = 0.95, standard error of the estimate = 11.4 ml/min, and intrapatient coefficient of variation = 16.9%. However, this formula tended to overestimate GFRs < 30 ml/min and to underestimate GFRs > 80 ml/min. The new one-compartment model is a modification of Bubeck's model, originally used for the determination of renal plasma blood flow. Using this modified model, there was an excellent correlation between 125I-iothalamate and nonradioactive iohexol clearance values at all levels of GFR tested: r2 = 0.95, standard error of the estimate = 9.2 ml/min, and intrapatient coefficient of variation = 13.7%. In conclusion, the determination of the plasma clearance of iohexol by a nonradioactive technique and a monoexponential model is a simple and accurate method of determining the GFR in patients with varying degrees of renal impairment.

Adult↗
PubMed1996

Risk factors for hospital utilization in chronic dialysis patients. Southeastern Kidney Council (Network 6).

It is not known if the risk factors for hospital utilization are similar to the risk factors for mortality in chronic dialysis patients. The risk factors associated with hospital days per year of patient risk were identified in a subset of patients in Network 6 (the states of North Carolina, South Carolina, and Georgia) who began dialysis in 1989. The demographic characteristics of this cohort of 1572 patients included a mean (+/- SD) age of 57.4 +/- 15.0 yr; 63.7% of the patients were African American, 52.4% were female, and 33.0% had diabetes mellitus as the primary cause of ESRD. The median number of hospital days per year of patient risk was 8.8, with 25th and 75th quartiles of 3.9 and 20.1, respectively. By using multiple regression analysis, the strongest predictors of the number of hospital days per year of patient risk included low serum albumin level (P = 0.0001), decreased activity level (P = 0.0006), diabetes mellitus as the primary cause of ESRD (P = 0.002), peripheral vascular disease (P = 0.004), white race (P = 0.01), increasing age (P = 0.03), the absence of hypertension (P = 0.03), and the presence of angina (P = 0.03), smoking (P = 0.03), and congestive heart failure (P = 0.045). These risk factors are similar to those reported for an increased risk of mortality in dialysis patients and some of them, such as smoking, are modifiable and may be amenable to interventional strategies.

Adult↗
PubMed1995

Changes in peritoneal transport during the first month of peritoneal dialysis.

OBJECTIVE: To determine if peritoneal transport characteristics change during the initial month of peritoneal dialysis. DESIGN: Retrospective review of peritoneal equilibration test (PET) results in patients who received their first PET during the first two weeks of peritoneal dialysis (early PET group) versus patients who received their first PET between four and 28 weeks after the initiation of dialysis (late PET group). The initial PET values were compared to subsequent PET results obtained approximately seven months after the initial PET. SETTING: Peritoneal dialysis unit of a tertiary medical center. OUTCOME MEASURES: PET results and calculated mass transfer area coefficient (MTAC) values. PATIENTS: Thirty-four peritoneal dialysis patients in the early PET group and 17 peritoneal dialysis patients in the late PET group. RESULTS: In the early PET group, there was a statistically significant increase from the initial to follow-up values for both dialysate-to-plasma (D/P) creatinine and MTAC creatinine (p < 0.01) as well as a significant decrease for four-hour dialysate to initial dialysate ratios (D/Do) glucose (p = 0.08) and MTAC glucose (p < 0.05). In the late PET group, there was no significant change in any of these parameters with time. However, in the late PET group, there was a significant decrease in D/P urea values with time (p < 0.01), but not with MTAC urea. In addition, there were no differences over time in either group for serum albumin or hematocrit values. CONCLUSION: During the first two weeks of peritoneal dialysis, there tends to be a change in peritoneal transport characteristics in some patients. PET data obtained during this time period should be interpreted as preliminary.

Biological Transport↗
PubMed1994

The effect of increasing hematocrit on peritoneal transport kinetics.

Although it is well established that an increase in hematocrit results in a small decrease in solute transport in hemodialysis patients, the effect of hematocrit on solute transport in peritoneal dialysis patients remains controversial. In hemodialysis patients, the inverse relationship between hematocrit and the transport of small solutes may be explained by the dependence of solute clearance on the rapidity of solute movement from the red blood cell to the dialysate. This movement is determined by several in vivo factors, the most important of which is blood flow. However, in peritoneal dialysis, the effective peritoneal capillary blood flow is several times the maximal urea clearance. Therefore, clearances are usually considered to be independent of blood flow rate and variations in hematocrit should not affect solute transport across the peritoneal membrane. In this study, the effect of an increase in hematocrit on the transport of small solutes in peritoneal dialysis patients is analyzed. The peritoneal equilibration test was performed in 25 continuous ambulatory peritoneal dialysis patients before and after an increase in hematocrit of at least seven points. No significant change was found in ultrafiltration rate or in peritoneal transport characteristics as measured by the peritoneal equilibration test or by mass transfer area coefficients for creatinine, urea, or glucose. In addition, there was no change in these parameters in a control group of 13 continuous ambulatory peritoneal dialysis patients with no significant change in hematocrit. These findings are consistent with the observation that solute clearance for urea and creatinine in peritoneal dialysis is not blood flow dependent.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Determination of peritoneal transport characteristics with 24-hour dialysate collections: dialysis adequacy and transport test.

Although the 24-hour collection of dialysate provides a very accurate measure of the adequacy of dialysis, it is not known if it can also determine peritoneal membrane transport characteristics. In this prospective study, 101 24-hour dialysate collections were immediately followed by a standard peritoneal equilibration test (PET). Four- and 24-h dialysate-to-plasma (D/P) ratios were determined for creatinine and urea. The correlation coefficients between these two tests were 0.86 for the adjusted D/P creatinine and 0.71 for the D/P urea, whereas the standard errors of estimate were 0.054 and 0.060, respectively. Patients were classified into one of four transport groups on the basis of the mean and standard deviation of the adjusted D/P creatinine values, and these values were similar to those generated from the PET data. Rates of ultrafiltration were also defined for patients undergoing 2.0- and 2.5-L dwells. A survey of a subset of these patients demonstrated that the 24-h collection was preferred to the PET for determining transport characteristics. Therefore, the 24-h dialysate collection can be used to monitor both peritoneal membrane transport characteristics and adequacy. This technique, which has been named the "dialysis adequacy and transport test," has the potential for significant cost savings when it is used for the routine follow-up of both peritoneal transport and adequacy of dialysis.

Adolescent↗
PubMed1993

Prevalence of missed treatments and early sign-offs in hemodialysis patients.

Hemodialysis patients often do not complete their full amount of time on dialysis and at times miss their hemodialysis treatments completely. However, neither the magnitude nor the potential reasons for this problem are known. The prevalence of unauthorized absences from hemodialysis sessions (no shows) and both the prevalence and reasons for early terminations from hemodialysis sessions (early sign-offs) were prospectively studied at a large hemodialysis unit in the southeastern United States. This unit provided a total of 31,212 hemodialysis sessions in a 12-month period to an average of 231 patients. There was a total of 2,108 early sign-offs (6.8 +/- 0.9%/mo) and 387 "no-shows" (1.2 +/- 0.2%/mo) during this 12-month period. The most common reasons for early sign-off were cramping (17.9%), followed by "feels bad or sick" (14.2%), personal business or errands (12.1%), lack of transportation later in the day (7.7%), and refusal to comply with the prescribed treatment time (6.4%). In sum, approximately 55% of early sign-offs were due to medically related problems, whereas most of the remainder occurred because of either personal obligations or noncompliance with the dialysis prescription. This information should be of value when designing programs intended to reduce the number of early sign-offs in hemodialysis patients.

Adult↗
PubMed1993

The efficacy number as a predictor of morbidity and mortality in peritoneal dialysis patients.

The efficacy number has been proposed as a predictor of clinical outcome in patients on chronic ambulatory peritoneal dialysis (CAPD). The usefulness of this parameter in a large group of CAPD patients was analyzed. Forty-five patients who have received chronic CAPD therapy for at least 1 yr were included in the study. The efficacy number was compared with outcome as defined by mortality and days of hospitalization. Other demographic and laboratory parameters, including gender; race; presence of diabetes; serum albumin, serum creatinine, and BUN levels; and measures of peritoneal transport, including dialysate-to-plasma creatinine and dialysate-to-plasma urea ratios, were also assessed for their role in predicting outcome. Laboratory values were obtained at the initiation of CAPD and at 12 months after the start of CAPD. By univariate analysis, a low 12-month serum albumin level was the best predictor of mortality (P < 0.005), followed by a high 12-month efficacy number (P < 0.05). After adjusting for age and the presence of diabetes, these two variables remained the best predictors of mortality (P < 0.08 and < 0.09, respectively). A low initial serum albumin level was also a strong predictor of mortality (P < 0.09). By univariate analysis, the best predictor of hospitalization was a low serum albumin level obtained either initially or at 12 months (P < 0.005 for both time periods). After adjusting for age and the presence of diabetes, the 12-month serum albumin level remained a significant predictor of hospitalization (P < 0.03), whereas efficacy number was not a strong predictor (P = 0.27).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Assessment of dialysis dose by measured clearance versus extrapolated data.

OBJECTIVE: To determine whether estimates of daily dialysis clearance of creatinine and urea, based on data from the 4-hour peritoneal equilibration test, correlate well with daily dialysis clearance measured by 24-hour dialysate collection in chronic ambulatory peritoneal dialysis patients. DESIGN: Prospective study in which each subject collected all dialysate from a 24-hour period and then immediately thereafter underwent a standard peritoneal equilibration test (PET). Daily clearances of creatinine and urea were calculated from 24-hour dialysate collections by standard methods and then were compared with several estimates of 24-hour clearance based on PET data. SETTING: Single peritoneal dialysis unit of a university teaching hospital. PATIENTS: Thirty-six stable patients on continuous ambulatory peritoneal dialysis (CAPD). MAIN OUTCOME: The estimated values for daily dialysis clearance both overestimated and underestimated the measured 24-hour clearance. The correlation coefficient between the extrapolations and the actual 24-hour clearances ranged from 0.63-0.68. The range of discordance for daily creatinine clearance was from -2530 mL/day to +2199 mL/day. For daily urea clearance, the range of discordance was from -2103 mL/day to +1940 mL/day. The peritoneal membrane transport characteristics of the individual patient did not predict whether the extrapolation overestimated or underestimated the measured daily clearance. CONCLUSION: Extrapolation of PET data is not a reliable method to estimate the dose of dialysis delivered to the patient. A 24-hour collection of dialysis is necessary for this determination.

Adolescent↗
PubMed1992

Elevated glucose stimulates TGF-beta gene expression and bioactivity in proximal tubule.

Our previous studies have demonstrated that raising ambient glucose from 100 to 450 mg/dl significantly inhibited the proliferation of mouse renal proximal tubule cells in culture. This effect was demonstrated after a latent period of 24 to 48 hours. Because transforming growth factor-beta (TGF-beta) inhibits cell proliferation in most epithelial cell lines, we hypothesized that the inhibitory effect of high glucose levels on cell proliferation may be mediated by TGF-beta. The present studies were performed to test the hypothesis that TGF-beta is an autocrine cytokine whose activity can be modulated by ambient glucose. Exogenous TGF-beta inhibited [3H]-thymidine incorporation in a dose-dependent fashion and with high affinity (picomolar range), but with slightly lower potency in high versus normal glucose media. Northern analysis of mRNA demonstrated that proximal tubule cells constitutively express TGF-beta 1 transcripts, and that the steady state level of TGF-beta 1 mRNA was, on average, 63% higher in the cells grown for 48 hours in high versus normal glucose media. Furthermore, the conditioned media of cells exposed to 450 mg/dl glucose exhibited endogenous TGF-beta bioactivity as measured by inhibition of cell proliferation. The addition of a rabbit antiporcine TGF-beta neutralizing antibody significantly increased basal thymidine incorporation in high glucose media to levels approaching those of cells grown in normal glucose media. In contrast, the anti-TGF-beta antibody did not have a significant effect on the growth of cells in the normal glucose media.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1992

Attenuated expression of epithelial cell adhesion molecules in murine polycystic kidney disease.

Polycystic kidney disease is an inherited disorder of parenchymal structure that leads to renal failure. Cysts begin as focal dilations in proximal tubules and collecting ducts, giving rise to cyst walls lined by a phenotypically disturbed epithelium that expresses dysfunctional transport and matrix proteins. We used an mRNA search protocol to probe efficiently for tissue-specific disturbances that might underlie the formation of cysts. This search assessed the relative abundance of transcripts encoding a variety of growth factors (transforming growth factor-beta 1, interleukin-6, tumor necrosis factor, and endothelin-1), structural proteins (collagen IV, nidogen, fibronectin, and laminins A and B1), and cell adhesion molecules (CAMs; E-cadherin, N-CAM, laminin receptor, and fibronectin receptor) in the cystic kidneys of cpk/cpk mice and uncovered a previously unrecognized early reduction in mRNA encoding N-CAM (54%) and E-cadherin (56%) (n = 5; P less than 0.001). Levels of transcripts for growth factors, structural proteins, and for fibronectin and laminin receptors in normal and cystic kidneys were generally similar. The reduction in transcripts for N-CAM and E-cadherin in kidneys from cystic mice was not observed in autologous liver. The immunofluorescent staining of cystic kidneys confirmed that the decrease in N-CAM and E-cadherin was generally confined to regions abundant in developing cystic epithelium. The presence of both N-CAM and E-cadherin appears to guide the sequential differentiation and polarization of normal renal epithelium, and their attenuated expression in the kidney of cpk/cpk mice may be a material factor contributing to the pathogenesis of cyst formation.

Animals↗
PubMed1984

Prognostic factors for splenectomy response in adult idiopathic thrombocytopenic purpura.

The prognostic factors for splenectomy response were evaluated in 40 adult patients with idiopathic thrombocytopenic purpura (ITP). We defined the corticosteroid response on the basis of the platelet count after seven to ten days of therapy, rather than at some time after discontinuing corticosteroid agents, as previously reported in the literature. Initial corticosteroid response was statistically significant in predicting splenectomy response; age and sex were marginally significant; duration of symptoms and spleen weight were not predictive. Of 30 patients with a minor or complete response to corticosteroids, 28 (93%) responded to splenectomy; of ten patients unresponsive to corticosteroids only four (40%) responded to splenectomy (P less than .001). Eighty-two percent of the patients in the complete responder group are projected to be continually relapse-free at 96 months. Only one of the patients in this group died; the nonresponders to splenectomy had a median survival of only ten months.

Actuarial Analysis↗