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Biomedical subjects

S Sandroni

Publications and source records attributed to S Sandroni.

At least 19 recordsLinked to original sources
PubMed1992

Aluminium intoxication in undialysed adults with chronic renal failure.

The dialysis encephalopathy syndrome (DES) consists of altered mental status, communication difficulty, seizures and myoclonus. It has been attributed to elevated serum aluminium (A1) levels. Two undialysed patients with chronic renal failure who presented with the characteristic syndrome are reported. The first, a 48 year old female, had used A1 containing phosphate binders for two years. Her serum A1 level was 25.34 mumol/L. Despite treatment with desferoximine and dialysis, she died. Necropsy revealed elevated A1 levels in the cerebral cortex (19 mcg/gm) and spongioform change in the outer three cortical layers. The second patient, a 46 year old woman, had a serum A1 of 8.70 mumol/L. She had never taken A1 containing phosphate binders but had taken several grams/day of citrate for at least six months. Treatment with haemodialysis and discontinuation of the citrate produced a resolution of symptoms and return of the A1 level to normal. During two years of haemodialysis there has been no recurrence.

Aluminum↗
PubMed1992

Performance characteristics of contemporary hemodialysis and venovenous hemofiltration in acute renal failure.

UNLABELLED: Modality choice in the treatment of acute renal failure (ARF) should be based on the match between individual patient needs and the characteristics of available therapies. Considerations include access, risk of bleeding, hemodynamic instability, and ability to remove excess volume. We prospectively studied 547 consecutive treatments for ARF in 110 patients to determine the performance features of modalities based on single-vessel venous access: hemodialysis (HD) and venovenous hemofiltration (VVH). All treatments were performed in an 18-month period at a single center. Patients' ages ranged from 16 to 84 years; 26 were trauma cases; 69 patients expired during their hospitalization. Mean number of treatments per patient was 4.97. Mean treatment duration was 197 min. Heparin was used unless active bleeding was present or felt to be a high risk; mean dose required was 2628 units. Pressor therapy was in progress prior to initiation of 260 (48%) of treatments. RESULTS: pretreatment and posttreatment mean systolic and diastolic BP were unchanged for the group. Forty-three (7.9%) treatments were terminated prematurely; of these only 27 (4.9%) were due to hypotension. No patient developed clinically apparent bleeding during any treatment. Contemporary equipment and techniques allow for provision of high-quality intermittent therapy for ARF, with excellent hemodynamic stability. Shorter, single-vein access treatments are advantageous for severely ill or injured patients who often undergo invasive monitoring and multiple studies or procedures.

Acute Kidney Injury↗
PubMed1992

Marked improvement in parameters of renal osteodystrophy with the use of intraperitoneal calcitriol.

Parenteral administration of Calcitriol is felt to be superior to oral Calcitriol in the treatment of renal osteodystrophy in chronic renal failure patients. We analyzed the results of serum calcium, phosphorus, alkaline phosphatase, and N-terminal parathormone level which are the clinical parameters of renal osteodystrophy in twenty-three chronic peritoneal dialysis patients who received varying dosages of intraperitoneal Calcitriol. The results which were analyzed at the end of one to twenty-three months revealed significant increase in serum calcium and a significant decrease in the values of alkaline phosphatase and N-terminal parathormone level.

Alkaline Phosphatase↗
PubMed1992

Antibody to hepatitis C virus increases with time on hemodialysis.

We studied whether chronic hemodialysis is associated with an increased risk of exposure to hepatitis C virus. Utilizing a first generation Elisa assay (C-100 Elisa, Ortho Diagnostic Systems, Raritan, NJ) and the Chiron RIBA HCV second generation assay (RIBA, Chiron, Emeryville, CA and Ortho Diagnostic Systems, Raritan, NJ), antibody to HCV was found in 31 of 87 hemodialysis patients (36%). Patients on hemodialysis less than 2 years had an antibody incidence of 15% (n = 46), as contrasted with a 59% incidence for patients on dialysis greater than or equal to 2 years (n = 41). We were unable to demonstrate a correlation of HCV-antibody positivity with history of blood transfusion. The overall incidence is higher than previously reported for hemodialysis patients in the United States. The very high incidence found in patients on dialysis greater than or equal to 2 years suggests that factors in the hemodialysis unit might contribute to the spread of virus.

Blood Transfusion↗
PubMed1991

Sudden blindness associated with central nervous symptoms in a hemodialysis patient.

Purtscher's-like retinopathy as a cause of sudden blindness in hemodialysis patients is not widely known. This is believed to occur secondary to leukoembolization to retinal arterioles following complement activation. We describe a patient who developed sudden but reversible loss of vision on hemodialysis associated with varying reversible neurological signs and symptoms which we felt may have been a manifestation of leukoembolic aggregates lodging in the arterioles of the retina and central nervous system circulations.

Adult↗
PubMed1991

Calcium excretion in preeclampsia.

Recent studies have suggested that preeclampsia is associated with hypocalciuria. We compared 24-hour urine data from 143 obstetric patients: 33 with preeclampsia, 58 normotensives, and 52 patients with gestational hypertension. The mean maternal age, race, and parity of these three groups did not differ significantly. The patients with preeclampsia had significantly less excretion of total calcium (129.7 +/- 18.7 mg/24 hours) (mean +/- SEM) than normotensives (283.9 +/- 12.3) or those with gestational hypertension (233.2 +/- 22.3) (P = .0001). The mean arterial pressure and excretion of total protein were significantly increased in the preeclampsia group (P = .0001). Using the receiver operator curve, a urine calcium threshold of 12 mg/dL was chosen as predictive for the development of preeclampsia, with a sensitivity of 85%, specificity of 91%, and positive and negative predictive values of 85 and 91%, respectively. Urinary calcium levels below 12 mg/dL may help distinguish preeclampsia from other hypertensive disorders of pregnancy.

Adult↗
PubMed1991

DUE criteria.

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Drug Evaluation↗
PubMed1990

Feasibility of in-center staff-assisted cycler dialysis.

Many debilitated elderly patients are not currently considered for peritoneal dialysis because they cannot perform the procedure themselves and they lack adequate back-up support in the family or extended care facility. They often tolerate hemodialysis poorly, and may exhaust their vascular access sites. We have provided intermittent in-center staff-assisted cycler dialysis to two debilitated elderly patients for a total of 12 patient months. Initial peritoneal equilibration tests indicated high solute transport rates in both patients, and led us to evolve a regimen based on frequent cycles. We use a 4 days a week regimen, cycling 12-14 liters during a 7.5 hour period each day. The patients tolerated the treatment well, with improved control of fluid balance and maintenance or improvement in appetite compared to baseline periods of CAPD. Mean pre-treatment BUN is 87 mg/dl. This is 29% higher than during CAPD, and has been stable. The requirement for additional nursing care has been variable but not disruptive of other activities once we established a dedicated space and routine. Current cycler technology permits consideration of in-center cycling as a practical alternative for many patients previously excluded from peritoneal dialysis.

Aged↗
PubMed1989

Context of social awareness: prelude to social service.

A required period of social service has recently been suggested as an addition to the medical school curriculum. The intent of this action is to improve the social sensitivity of physicians. If such a requirement is not placed within the appropriate context it may fail to achieve its objectives. Attention to institutional commitment, faculty experience, student selection, and supporting didactic materials are offered as suggestions to improve the utility of a social service requirement.

Curriculum↗
PubMed1989

Cycler dialysis evolution.

Use of automated cycler equipment is currently limited to a fraction of the peritoneal dialysis population. Various technical barriers combined in the past to inhibit its wider application. We have treated forty-seven patients over an eight year period with cycler dialysis, and have observed the evolution of this modality from a treatment of last resort to a first choice therapy for many patients--especially those who work.

Hemodialysis, Home↗
PubMedDate not supplied

Residency reform.

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Humans↗
PubMedDate not supplied

Emergency department evaluation and management of dialysis patient complications.

The number of dialysis patients in the United States has markedly increased in recent years to more than 100,000. An emergency physician is increasingly likely to be presented with the challenge of handling the emergent problems of the dialysis patient. This article is a review of the complications seen in the population of hemodialysis and peritoneal dialysis patients, with recommendations for emergency department evaluation and management.

Abdomen, Acute↗