bluuebunny/crossref_metadata_2025 huggingface dataset:
Cognitive-Behavioral Therapy for Idiopathic Infertile Couples
Authors: Tuschen-Caffier Brunna , Florin Irmela , Krause Walter , Pook Martin
Published: April 2003

Background: The purpose of this pilot study was to evaluate the impact of a 6-month cognitive-behavioral therapy for infertile couples. Methods: Seventeen idiopathic infertile couples participated in a therapy program comprised of modules to behaviorally optimize the chance of conception, improve sexual functioning and satisfaction, reduce thoughts of helplessness and, if necessary, improve marital communication skills. Pre- to posttreatment changes in the therapy group were compared to changes in two control groups. Results: The therapy group showed an improvement in sperm concentration, a reduction in thoughts of helplessness and a decrease in marital distress. By the end of therapy participants practiced timed intercourse more reliably and reported unchanged sexual pleasure and satisfaction during the nonfertile period of the menstrual cycle. At the 6-month follow-up, problem-focused thoughts had decreased. The live birth rate was higher in the therapy group than in epidemiological samples. Conclusion: Preliminary data suggest that cognitive-behavioral treatment may be an effective approach for the treatment of infertility.
Relationship between Stress Coping and Personality in Patients with Major Depressive Disorder
Authors: Uehara Toru , Sakado Kaoru , Sakado Miwako , Sato Tetsuya , Someya Toshiyuki
Published: April 2003

Background: Stress coping is defined as a behavioral or cognitive response of an individual to uncomfortable or difficult situations. It has been suggested that coping, like personality, is related to the pathology and course of mental disorders. Accordingly, we here used a clinical sample to investigate the relationships between coping strategies and personality traits. Methods: Subjects were 60 outpatients who were in remission from major depressive disorder and who completed the Coping Inventory for Stressful Situations (CISS) and the Munich Personality Test (MPT). Results: Task-oriented coping showed a positive correlation with extraversion and frustration tolerance. Emotion-oriented coping was closely associated with neuroticism, esoteric tendencies and isolation tendency. Avoidance-oriented coping was related to extraversion. Principal component analysis indicated three corresponding factors between coping and personality; one was related to psychopathology (loading from the neuroticism, esoteric tendencies and isolation tendency scales of the MPT, and from the emotion-oriented coping scale of the CISS), a second was a social-adaptive ability component (loading from the frustration tolerance and extraversion scales of the MPT, and from the task-oriented coping and avoidance-oriented coping scales of the CISS), and a third was a passive-avoidance coping component (loaded from the emotion-oriented coping and avoidance-oriented coping scales of the CISS only). Conclusion: Some personality traits such as extraversion and frustration tolerance are significantly related to task-oriented coping, and psychopathological personality traits such as neuroticism are associated with emotional-oriented coping in major depressive disorder.
Eating Problems and Related Weight Control Behaviour in Adult Japanese Women
Authors: Nakamura Kazutoshi , Hoshino Yoshihiko , Watanabe Atsushi , Honda Kyoichi , Niwa Shinichi , Yamamoto Masaharu
Published: April 2003

Background: Fewer studies concerning eating problems have been conducted in adult than in adolescent female populations. The aims of this study are to ascertain the proportion of eating problems and clarify weight control behaviour in adult Japanese women. Methods: This study employed a questionnaire survey with a cross-sectional design. Subjects were adult females aged 20–39 years, working in a computer factory. Four hundred and six women agreed to participate in the study. The questionnaire elicited self-reported age, body height, body weight and various histories of dieting, fasting and purging behaviour. The Eating Attitudes Test 26-item version (EAT-26) was also administered. Subjects showing an EAT-26 score equal to or greater than 20 were identified as having eating problems. Results: Among the subjects, 172 women (42.4%) had some history of dieting behaviour and 24 (5.9%) had some history of fasting behaviour. Regarding misuse of laxatives, diet pills and diuretics for the purpose of weight loss, 50 (14.3%) were past or current users of diet pills, followed by 42 (10.3%) laxative abusers and 15 (3.7%) diuretic abusers. Six (1.5%) subjects had an EAT-26 score of 20 or greater, 5 (1.9%) in their 20s, and 1 (0.8%) in her 30s, the difference not being statistically significant. Conclusions: Although dieting behaviour is common in adult Japanese working women, the proportion of eating problems is low in comparison with Western adult populations.
Cognitive Change following Cognitive Behavioural Therapy for Non-Cardiac Chest Pain
Authors: van Peski-Oosterbaan Anke S. , Spinhoven Philip , van der Does A.J. Willem , Bruschke Albert V.G. , Rooijmans Harry G.M.
Published: April 2003

Background: Seventeen to 43% of patients with non-cardiac chest pain suffer from anxiety/panic disorders. Cognitive behavioural therapy (CBT) is effective in reducing non-cardiac chest pain. However, no data are available indicating that pain reduction following CBT may be cognitively mediated or whether success of CBT is dependent on the presence of panic. The aim of the study was threefold: (1) does CBT have a differential effect on cognitive measures; (2) does a relationship exist between improvement in non-cardiac chest pain and changes in cognitive measures, and (3) can panic be established as a moderator of the effect of treatment? Methods: Sixty-five patients with non-cardiac chest pain completed a randomised trial comparing study CBT with ‘care as usual’. Dependent measures were: frequency of chest pain, anxiety, the fear of bodily sensations, attributions and catastrophic cognitions. Results: CBT had a differential effect on most of the cognitive measures. Pain reduction was associated with the development of more adequate cognitions with respect to chest pain, independent of anxiety reduction. Although panic patients reported higher baseline scores on the cognitive measures, no differences in treatment results were found between panic and no-panic patients. Conclusions: Pain reduction following CBT may be cognitively mediated. The presence of panic did not affect the outcome of treatment, implying a broad applicability of the cognitive model for treatment of patients with non-cardiac chest pain.
The Weeping Behavior in Anorexic and Bulimic Females
Authors: Mangweth Barbara , Kemmler Georg , Ebner Christoph , De Col Christine , Kinzl Johannes , Biebl Wilfried , Vingerhoets Ad
Published: April 2003

Background: The aim of the study was to examine the proneness, the functions and triggering situations of weeping in anorexic and bulimic women. Methods: Participants were 36 anorexic and 31 bulimic female patients and 56 age-matched female controls. All women completed the Questionnaire on Adult Crying. We limited our study to results on ‘crying proneness’, ‘functions of crying’ and ‘determining factors of crying’. Results: Bulimic patients reported to have cried significantly more often in the last 4 weeks, to be more likely to cry in situations of distress and to have used weeping significantly more often as a manipulative behavior than control women. Anorexic patients rated their tendency to cry significantly lower and experienced weeping as significantly more negative than controls. Conclusions: Compared to control women, anorexic patients associated weeping with negative feelings as opposed to bulimic patients who appeared to use weeping on an intentional basis. These deviations from control women seem to mirror the introvert character of anorexic patients and the extrovert impulsive personality of patients with bulimia nervosa, respectively.
Factors Affecting Compliance with Treatment in an Outpatient Child Psychiatric Practice: A Retrospective Study in a Community Mental Health Centre in Athens
Authors: Lazaratou H. , Vlassopoulos M. , Dellatolas G.
Published: April 2003

Background: The literature review shows that treatment compliance in child psychiatric practice is a multifactorial issue that includes parameters such as the type of problem presented by the child, the family’s functioning and the therapeutic team’s organization and functioning. Methods: In order to examine these parameters and their inter-relationship, epidemiological data from the files of 455 cases, representing the total number of cases admitted to our Centre between 1990–1994, were collected. We noted that the majority of patients (58.6%) failed to comply with treatment. Results: The statistical analysis shows that the sex and age of the child, the socio-economic status of the family, the family’s size, the parents’ educational background as well as the referral source are unrelated to compliance. On the contrary, the type of problem presented by the child, the type of recommended treatment, the number of sessions attended and the season of admission are correlated with treatment compliance. Conclusions: Certain aspects of our team’s techniques concerning the admission procedure, therapeutic contract and parental counselling have been re-examined and improved.
Relationship between Alexithymia, Dissociation and Personality in Psychiatric Outpatients
Authors: Wise Thomas N. , Mann Lee S. , Sheridan Michael J.
Published: April 2003

Background: The relationship between alexithymia and dissociation is not known. Both mechanisms ward off overwhelming affective states; hence, this report examines the relationship between dissociation, alexithymia, depressed mood and the five-factor model of personality in a sample of psychiatric outpatients. Methods: One hundred and sixteen outpatients were evaluated using the Toronto Alexithymia Scale (TAS), the Dissociative Experiences Scale (DES), NEO Five-Factor Inventory and visual analog scales assessing depression and anxiety. Data was analyzed using multivariate analysis of variance, logistic regression and linear regression techniques. Results: Depressed mood accounted for the group differences between the global TAS and DES scores. Using DES both dimensionally and categorically with regression models, there was minimal contribution of DES or its subfactors to predict TAS. Conclusions: These data reaffirm previous findings that dissociation fundamentally differs from alexithymia. Dissociation involves a change of one’s sense, of self, whereas alexithymia reflects a cognitive state of externally oriented thinking with an inability to identify and report discrete emotions.
Psychosomatic Medicine: Emerging Trends and Perspectives
Authors: Fava Giovanni A. , Sonino Nicoletta
Published: April 2003

Developments have occurred in all aspects of psychosomatic medicine. Among factors affecting individual vulnerability to all types of disease, the following have been highlighted by recent research: recent and early life events, chronic stress and allostatic load, personality, psychological well-being, health attitudes and behavior. As to the interaction between psychological and biological factors in the course and outcome of disease, the presence of psychiatric (DSM-IV) as well as subclinical (Diagnostic Criteria for Psychosomatic Research) symptoms, illness behavior and the impact on quality of life all need to be assessed. The prevention, treatment and rehabilitation of physical illness include the consideration for psychosomatic prevention, the treatment of psychiatric morbidity and abnormal illness behavior and the use of psychotropic drugs in the medically ill. In the past 60 years, psychosomatic medicine has addressed some fundamental questions, contributing to the growth of other related disciplines, such as psychoneuroendocrinology, psychoimmunology, consultation-liaison psychiatry, behavioral medicine, health psychology and quality of life research. Psychosomatic medicine may also provide a comprehensive frame of reference for several current issues of clinical medicine (the phenomenon of somatization, the increasing occurrence of mysterious symptoms, the demand for well-being and quality of life), including its new dialogue with mind-body and alternative medicine.
The Prevalence and Differential Diagnosis of Subclinical Depressive Syndromes in Inpatients 60 Years and Older
Authors: Schneider Gudrun , Kruse Andreas , Nehen Hans-Georg , Senf Wolfgang , Heuft Gereon
Published: April 2003

Background: Depressive syndromes that do not comply with the diagnostic criteria for specific depressive disorders are designated as ‘subclinical’ or ‘subsyndromal’ depressive syndromes. Using our own data from a clinical study, this paper outlines the significance of subclinical depressive syndromes and demonstrates the problems of differentiating between depressive and subclinical depression (SD) syndromes and organic mood disorders especially in an elderly population with medical comorbidity. Methods: Two hundred and sixty-two patients aged 60 years and older in a general hospital were investigated, using a clinical psychiatric interview, expert ratings and self-report scales after extensive internal medical diagnostic evaluation. Results: When, without further differentiation as to their origin, all symptoms required by symptom checklists according to ICD-10 were considered for the diagnosis of major depression (MD), 35.5% of the study participants fulfilled the diagnostic criteria. After differentiating for etiology of symptoms, MD was found in only 14.1%, SD was diagnosed in 17.6% and organic mood disorder in 12.2% of the study participants. In another 41 patients (15.6%), symptoms of depression not fulfilling ICD-10 criteria were classified as being of organic or drug-induced origin. SD patients were in a mean position between nondepressive and depressive patients with regard to social isolation and physical impairment; women were overrepresented in the depressive and subdepressive groups. Conclusions: SD and organic mood disorder are common and helpful diagnostic categories in the elderly. The results show that in old age there is substantial danger of confounding MD, SD and organic mood disorder, thus leading to erroneously high prevalence rates of MD and underestimations of organic mood disorder if depressive symptoms are recorded only by self-report scales or a symptom checklist. Both internal and psychosomatic-psychotherapeutic competence as well as a liaison service in general hospitals are necessary for the differential diagnosis of MD, SD and organic mood disorder in the elderly with medical comorbidity.
Psychosocial Indexes and Cardiovascular Risk Factors in a Community Sample
Authors: Coelho Rui , Ramos Elisabete , Prata Joana , Barros Henrique
Published: April 2003

Background: Psychosocial characteristics might contribute to a more comprehensive understanding of cardiovascular disease as it is increasingly recognised that biomedical risk factors do not fully explain its dynamics. This study aimed to describe psychometric indexes in a Portuguese community sample relating them to known cardiovascular disease risk factors. Methods: Anthropometric, blood pressure, serum measurements and information on demographic, social, medical and behavioural characteristics were obtained for 215 women and 156 men. Self-administered questionnaires were used for the psychometric evaluation (Bortner scale, Beck Depression Inventory, Hopkins Symptom Distress Checklist 90-Revised, Psychological General Well-Being and the Nottingham Health Profile, NHP). Results: There were significant differences according to gender regarding almost every psychometric dimension assessed. After adjusting for the presence of different biomedical risk factors, significant decreasing mean behaviour pattern scores were found with increasing age. Mean depression scores were significantly higher in women and in individuals with lower educational level. As to general psychological well-being, the highest scores were obtained for men and individuals with higher educational level. For the assessed dimensions of quality of life, as well as indexes of psychopathology, men scored better than women. No significant differences in mean scores of behaviour pattern, depression, psychological general well-being and dimensions of NHP were found according to the presence of an increasing number of cardiovascular risk factors. Conclusions: The study shows that the clustering of multiple biomedical risk factors does not result in additive deleterious psychological effects and that psychometric indexes are mainly dependent on gender and education, common confounders in most studies evaluating cardiovascular risk factors.
Cognitive-Behavioural Therapy for Bulimia nervosa and Binge Eating Disorder
Authors: Ricca Valdo , Mannucci Edoardo , Zucchi Teresa , Rotella Carlo M. , Faravelli Carlo
Published: April 2003

Cognitive-behavioural therapy (CBT) programmes for bulimia nervosa (BN) have been considerably refined during the last 2 decades, and such a treatment is now extensively used. The present paper describes the treatment rationale and structure, and reviews the available evidence on its efficacy. Compared to any other psychological or pharmacological treatment for which controlled studies have been published, CBT is reported to be more effective (the majority of studies), or at least as effective. A CBT programme for binge eating disorder (BED) has been created by adapting that of BN, but it has been less extensively evaluated in field trials. Even here, however, no other treatment has proven to be of greater efficacy than CBT. Various methodological limitations reduce the possibility of generalizing these findings. Moreover, CBT was found to be completely satisfactory neither for BN nor for BED, with moderate effectiveness and some limits. However, at the present state of treatment, no other therapeutical procedure seems to be more effective, more specific or more promising. It is speculated therefore that CBT could be presently considered the first-choice remedy for these severely disabling disorders.
Two Different Pathways of Glomerular Enlargement in Adults with Focal and Segmental Glomerulosclerosis: A Morphometric Study
Authors: Matsumae Tomoji , Fukuzaki Makoto , Takebayashi Shigeo , Naito Setsuya
Published: April 2003

The renal biopsy specimens obtained from 15 adults with focal and segmental glomerulosclerosis (FSGS) and 15 adults with minimal change nephrotic syndrome (MCNS) were morphometrically analyzed using light and electron microscopy. Moreover, initial biopsy specimens obtained from 10 adults who were diagnosed as MCNS and developed FSGS, based on repeat biopsy findings (‘MCNS’-FSGS), were also analyzed using electron microscopy. After comparing the actual values between the groups of FSGS and MCNS, the mean glomerular volume, the capillary volume per a glomerulus, the capillary filtration surface per a glomerulus, and the capillary diameter (Cap-D) were all larger in the FSGS group than in the MCNS group. In regard to the morphological values in the ‘MCNS’-FSGS group, both values of the surface density of the capillary filtering surface and the capillary diameter at the first biopsy specimens as well as those in the FSGS group were higher than those in the MCNS group. When analyzing the structural parameters, in the FSGS series, we found a high association of the percentage of obsolescent glomeruli (%SG) with the mean glomerular volume, the capillary volume per a glomerulus, the capillary filtering surface per a glomerulus and the capillary length per a glomerulus, however we failed to demonstrate the correlation between the %SG and the Cap-D. Thus, the glomerular structure in the ‘MCNS’-FSGS patients, even at the first renal biopsy, resembled that in FSGS, suggesting FSGS to be a distinct entity from MCNS. These data indicate that the enlargement of the capillary volume, resulting from the widening of the capillaries, was the initial structural event for adults with FSGS, while the elongation of the capillaries appeared to reflect some compensatory process for the decrease in the functioning nephron.
De novo AL Amyloid in a Renal Allograft
Authors: Le Quoc C. , Wood Thomas C. , Alpers Charles E.
Published: April 2003

A 65-year-old woman developed nephrotic syndrome 7 years after receiving a cadaveric renal allograft. Renal biopsy and clinical laboratory evaluation revealed the underlying disease process to be AL amyloidosis. To our knowledge, this is the first reported case of de novo AL amyloid occurring in a renal allograft.
Free Circulating Magnesium and Renal Magnesium Handling during Acute Metabolic Acidosis in Humans
Authors: Blumberg Daniel , Bonetti Alessandro , Jacomella Vincenzo , Capillo Stellario , Truttmann Anita C. , Lüthy Christa M. , Colombo Jean P. , Bianchetti Mario G.
Published: April 2003

Ion-selective electrodes have been designed for determining the ionized concentration of magnesium in blood, the biologically active form of this ion. The effect of acute acidosis induced by ammonium loading on circulating and urinary magnesium was investigated in 11 volunteers. No changes in plasma total and ionized magnesium were noted following administration of ammonium chloride. On the contrary, administration of ammonium chloride increased the plasma free magnesium fraction and the urinary magnesium excretion. The study demonstrates that the hypermagnesiuria induced by acute acidosis is not caused by ionized hypermagnesemia and supports the theory that acidosis decreases the circulating magnesium fraction that is bound to proteins.
Acute Anuric Renal Failure in Nonfulminant Hepatitis A Infection
Authors: Jamil Shazia M. , Massry Shaul G.
Published: April 2003

Acute renal failure has recently been recognized as a rare complication of nonfulminant hepatitis A infection. The availability of a specific test for IgM antibody to hepatitis A should permit prompt diagnosis of the disease and a better evaluation of its association with acute renal failure. The exact mechanism for acute renal failure in hepatitis A is uncertain but glomerulonephritis, acute tubular necrosis and hepatorenal syndrome have been postulated. We report a patient with hepatitis A infection and acute renal failure most likely due to acute tubular necrosis.
Systemic Involvement and Uremia in a Patient with Tuberous Sclerosis
Authors: Bellinghieri Guido , Santoro Domenico , Savica Vincenzo
Published: April 2003

A patient with tuberous sclerosis who displayed all the manifestations of the disease had severe and refractory anemia and rapidly progressed to renal failure.
Recovery of Minimal Change Nephrotic Syndrome and Acute Renal Failure in a Patient withRenal Cell Carcinoma
Authors: Auguet Teresa , Lorenzo Alfons , Colomer Enrique , Zamora Alberto , García Carmen , Martínez-Vea Alberto , Richart Cristóbal , Oliver Jesús Àngel
Published: April 2003

We describe a 78-year-old patient with nephrotic syndrome due to minimal-change glomerulopathy, associated with a renal adenocarcinoma. Oliguric acute renal failure requiring hemodialysis was also observed. Surgical removal of the tumor and corticosteroid therapy resulted in resolution of the nephrotic state and improvement of the renal function. Nephrotic syndrome is an unusual complication of renal cell carcinomas, and the association of minimal-change glomerulopathy (MCG) and solid tumors is particularly uncommon. In spite of this, MCG should be considered in the nephropathies causing nephrotic syndrome and acute renal failure in patients with renal malignancies.
Extreme Diuretic Dependence in Idiopathic Edema: Mechanisms, Prevention and Therapy
Authors: Kuchel Otto , Ethier Jean
Published: April 2003

Idiopathic edema patients abusing diuretics are occasionally becoming dependent to such a degree on increasing doses of diuretics that their withdrawal results in severe cardiorespiratory failure, occasionally even pulmonary edema. Two such patients are described and 1 is investigated in depth as to the mechanism of the diuretic abuse-induced excessive tubular avidity for sodium. An extreme diuretic-induced secondary hyperaldosteronism and atrial natriuretic factor suppression, although tapering off when diuretics are stopped, results in a continuous tubular sodium hyper-reabsorption. Since the most affected patient was deprived of the benefits of converting enzyme inhibitors because of their side effects, the only way to partially overcome this condition was a generous combination of several diuretics acting at several segments of the nephron. This contrasted with a similar patient who was relatively well controlled by a converting enzyme inhibitor combined with lower dose diuretics. Diuretic abuse-induced secondary hyperaldosteronism and diuretic resistance are apparently best prevented by converting enzyme inhibitors. When nonpharmacological preventive measures fail, converting enzyme inhibitors are preferable to diuretics as the first-choice treatment of idiopathic edema patients.
Metabolic Factors in the Renal Response to Amino Acid Infusion
Authors: Claris-Appiani Aldo , Ardissino Gianluigi , Tirelli Amedea S. , Daccò Valeria , Corbetta Carlo , Guidi Laura , Moretto Eugenia , Assael Baroukh M. , Sereni Fabio
Published: April 2003

In order to investigate the renal effects of amino acids (AA) with different metabolic fate, we compared the changes in glomerular and tubular function, nitrogen metabolism and glucoregulatory hormones in 7 volunteers during two infusions, one of a complete solution of amino acids (MIX-AA), which included five AA electively metabolized at the splanchnic level, and the other of a solution containing only essential AA (EAA), which escape splanchnic metabolism. MIX-AA increased GFR and RPF (from 104 ± 6 to 122 ± 13 and from 488 ± 46 to 572 ± 34 ml/min/1.73 m2), stimulated splanchnic metabolism as demonstrated by rises in urinary urea excretion (from 20.7 ± 2 to 30.6 ± 7.5 mg/min/1.73 m2) and the plasma glucagon/insulin ratio (from 21.4 ± 13 to 26.7 ± 15), and caused increases in fractional excretion of AA, FeNa and free-water clearance. During MIX-AA infusion significant correlations were observed between the individual values of GFR and the urea excretion rate (r = 0.66), and between GFR modifications (ΔGFR) and the plasma glucagon/plasma insulin ratio (r = 0.40). No change in renal function, urea excretion and the glucagon/insulin ratio was observed with EAA. An intermediate splanchnic step (increased plasma glucagon/insulin ratio and ureagenesis) seems necessary in the pathway leading to the nonessential AA-induced rise in GFR; this might stimulate an ultimate intrarenal pathway (possibly involving the diluting segment) via a still undefined mechanism.
Sympathetic Activity and Blood Pressure Pattern in Autosomal Dominant Polycystic Kidney Disease Hypertensives
Authors: Cerasola Giovanni , Vecchi Maurizio Li , Mulè Giuseppe , Cottone Santina , Mangano Maria Teresa , Andronico Giuseppe , Contorno Antonino , Parrino Irene , Renda Fabrizio , Pavone Giovanni
Published: April 2003

To study the potential role of sympathetic activity in the pathogenesis of arterial hypertension associated with autosomal dominant polycystic kidney disease (ADPKD) and to analyze its relationship with 24-hour blood pressure pattern, plasma catecholamines and 24-hour ambulatory blood pressure monitoring were evaluated in 30 ADPKD hypertensive patients (of which 17 without and 13 with renal failure) and in 50 essential hypertensives. The groups were matched for sex, body mass index, known duration of hypertension, and clinic blood pressure. Plasma catecholamines, determined in resting position, were higher in ADPKD patients without renal failure than in essential hypertensives. Nighttime diastolic blood pressure was higher and the percentage day-night difference in mean blood pressure was lower in hypertensives with ADPKD compared to patients with essential hypertension. Blood pressure was significantly correlated with plasma noradrenaline in ADPKD patients, independently of renal function. No significant differences were observed between ADPKD patients with and without renal failure, with respect to plasma catecholamines, 24-hour daytime and nighttime ambulatory blood pressures and the percentage day-night difference in mean blood pressure.
Urea Reduction Ratio and Urea Kinetic Modeling: A Mathematical Analysis of Changing Dialysis Parameters
Authors: Kessler Edward , Ritchey Nathan P. , Castro Frank , Caccamo Leonard P. , Carter Kimbroe J. , Erickson Barbara A.
Published: April 2003

Based mainly on the simplicity of its calculation, the urea reduction ratio (URR) has been suggested as an alternative to urea kinetic modeling (Kt/V) as a measure of hemodialysis adequacy. However, recent studies have raised questions concerning the accuracy of URR, particularly in the presence of residual kidney function (KrU). This study was initiated to evaluate the relationship between URR and Kt/V under a variety of dialysis conditions. Equations based on the variable-volume, single-pool model described by Gotch were used to construct a model incorporating the variables used in the estimation of URR and Kt/V. The model’s prediction of URR correlated closely with measured URR in 30 patients (r = 0.9987, p < 0.000001). This analytic approach showed that changes in each of several dialysis parameters caused divergence in the values of URR and Kt/V. The model showed that URR could be less than 0.65, while total Kt/V was greater than 1.2, whether or not KrU was present. In fact, when KrU was greater than 1.0, URR could be less than 0.65, while Kt/V might be 2.0 or higher. On the other hand, the model showed instances where URR could be greater than 0.65, when Kt/V was less than 1.2. This occurred only when KrU was less than 1.0. To determine the prevalence of these anomalies in clinical practice, 767 kinetic modeling determinations were evaluated in 207 patients. One of the above discrepancies was observed at least once in 30.9% of the patients, representing 12.1% of all determinations. In addition, it was found that omitting KrU from the calculation of Kt/V generally leads to a Kt/V <1.2. This, when associated with a URR <0.65, could erroneously imply inadequate dialysis. The patient data are consistent with the view that URR and Kt/V are the net result of several variables that may act together or even in opposing directions. Based on this mathematical model and the observed clinical data, the use of URR alone to assess dialysis adequacy, or neglecting the contribution of KrU to Kt/V, may lead to changes in the dialysis prescription that are neither correct nor necessary.
Hyperthyroidism in a Renal Transplant Recipient
Authors: Peces Ramón , Navascués Rafael A. , Baltar José , Laurés Ana S. , Ortega Francisco , Alvarez-Grande Jaime
Published: April 2003

We report a case of toxic multinodular goiter with severe symptomatic hyperthyroidism in a female diagnosed 5 months after successful renal transplantation. To our knowledge, this is the first well-documented case of hyperthyroidism in a renal transplant recipient that responded well to methimazole. Special attention should be made to the use of methimazole and the possible interaction with immunosuppressive drugs.
The Concept of ‘Glomerulonephritis’
Authors: Stratta Piero , Canavese Caterina , Sandri Luisa , Ciccone Giovannino , Santi Sonia , Barolo Stefano , Messuerotti Alessandra , Quaglia Marco , Mazzucco Gianna , Fop Fabrizio , Segoloni Giuseppe Paolo , Piccoli Giuseppe
Published: April 2003

Though the term ‘nephritis’ first appeared in the 19th century, this word did not bear the same meaning as it does today; indeed, for many years it was used to indicate ‘renal diseases’ (in the sense of Bright’s disease) in a larger sense. This review summarizes the long gestation of the concept of ‘glomerulonephritis’ from the prehistory of medicine up to the beginning of the second half of the 20th century with emphasis on Italy and, in particular, on Torino, which was the capital of the Kingdom of Italy from 1861 to 1865. To the best of our kowledge, this is the first study reporting an epidemiology survey of Bright’s disease in Italy from 1880 up to 1960. Towards the end of the 19th century, Bright’s disease accounted for 26 deaths/year/105 population (in comparison with more than 200 from tuberculosis) in Italy, roughly paralleling that reported in the USA. At the beginning of the 20th century, Bright’s disease was the seventh cause of death (almost 1% of total deaths) in Italy. Furthermore, in Italy, as elsewhere, autopsy studies showed a higher percentage of deaths attributed to Bright’s disease (5–7%) in comparison with those obtained from vital statistics. In 1960, just before the beginning of renal replacement therapy, Bright’s disease accounted for 15.7 deaths/year/105 population (= 1.46% of all deaths), roughly paralleling that reported in the United Kingdom (13.8/105 population = 1.25% of deaths). Probably, it was difficult to recognize the real incidence of chronic renal diseases leading to death in the 1960s, and vital statistics were able to furnish only approximate estimates. However, noteworthy is the fact that these values were very close to those estimated as being the annual need for renal replacement therapy (10–20 cases/year/105 population).
Berengario da Carpi
Authors: De Santo Natale Gaspare , Bisaccia Carmela , De Santo Luca Salvatore , De Santo Rosa Maria , Di Leo Vito A. , Papalia Teresa , Cirillo Massimo , Touwaide Alain
Published: April 2003

Berengario da Carpi was magister of anatomy and surgery at the University of Bologna from 1502 to 1527. Eustachio and Falloppia defined him as ‘the restaurator of anatomy’. He was a great surgeon, anatomist and physician of illustrious patients including Lorenzo II dei Medici, Giovanni dalle Bande Nere, Galeazzo Pallavicini, Cardinal Colonna, and Alessandro Soderini. He had strong links to the intellectuals of his time (Forni, Bonamici, Manuzio, Pomponazzi) as well as with the Medici family. He was respected by the Popes Julius II, Leo X and Clement VII. His main contributions are the Isogogae Breves, De Fractura calvae sive cranei, and the illustrated Commentaria on the Anatomy of Mondino de Liucci, a textbook utilized for more than 200 years, which Berengario aimed to restore to its initial text. The Commentaria constitutes the material for the last part of this paper which concludes with a personal translation of some passages on ‘The kidney’, where the author gives poignant examples of experimental ingenuity.
The History of Science: Defending Epistemology with New Technologies
Authors: Aliotta G. , De Angelis G. , De Santo N.G. , Sepe J. , Stingo V.
Published: April 2003

The leap in scientific discoveries made with new computer technologies can be compared to the invention of the printing press and expanding scientific thought in the 16th century. Nowadays, new communication technologies offering a multimedia contribution illustrate the fascinating reality of scientific exploration even for individuals who can otherwise not be reached. Since rare books are usually kept in libraries with limited access, the strict safekeeping, however, often overrides the need for academic consultation. Moreover, rare manuscripts are often illustrated with figures that are just as important as the written texts, but which are also unavailable. We combined our expertise in biology, medicine and multimedia to produce a CD-ROM with a hyperlinked text on the scientific revolution of the 16th century, focusing on the early conceptualization of life sciences in Europe. In this paper we show the first page of Malpighi’s Epistle II (De pulmonibus – on the Lungs) as it appeared in Opera Omnia published in London (1686) by the Royal Society.
Treatment of Secondary Hyperparathyroidism in Hemodialyzed Patients with High-Dose Calcium Carbonate without Vitamin D3 Supplements
Authors: Teruel José L. , Tenorio María T. , Rodríguez José R. , Marcén Roberto , Orofino Luis , Rivera Maite , Ortuño Joaquín
Published: April 2003

Background: Vitamin D compounds are usually indicated for the treatment of secondary hyperparathyroidism in dialysis patients. The possibility to induce a reversal of hyperparathyroidism with calcium supplementation alone is controversial. The present study was conducted to assess if oral calcium carbonate may constitute a therapeutic option for the control of hyperparathyroidism in patients with high PTH concentrations at the beginning of the treatment with chronic hemodialysis. Methods: Thirty-one patients with end-stage renal failure with an intact PTH concentration above 250 pg/ml at the beginning of chronic hemodialysis therapy were treated with high doses of calcium carbonate; no patient received either aluminium-containing binders or vitamin D compounds. To minimize hypercalcemia, a calcium dialysate concentration of 2.5 mEq/l was used in all patients. The goal of the study was to reduce the intact PTH concentration to 250 pg/ml with oral calcium carbonate supplements alone. Results: Throughout the first year on hemodialysis treatment, the intact PTH concentration decreased from 538 ± 256 to 251 ± 218 pg/ml (p < 0.001). By the end of the study, the therapeutic objective was achieved in 22 patients (71%) (‘responder’ group). The remaining 9 patients were classified as the ‘treatment failure’ group. The basal intact PTH concentration was not different between both groups (508 ± 235 vs. 612 ± 303 pg/ml, respectively, p = n.s.), but 5 ‘treatment failure’ patients admitted to take a dose of calcium carbonate lower than that prescribed. There were 40 episodes of hyperphosphatemia (11% of all measurements) in 7 of 31 patients, 5 of them belonged to the noncompliance ‘treatment failure’ patients. Only 15 episodes (4% of all measurements) of transient hypercalcemia (range 11.1 – 11.9 mg/dl) were detected in 8 patients. Conclusions: Secondary hyperparathyroidism in hemodialysis patients can often be reverted by oral calcium carbonate alone. But a good adherence to treatment is absolutely necessary.
Circadian Blood Pressure Changes and Cardiac Abnormalities in IgA Nephropathy
Authors: Szelestei Tamás , Kovács Tibor , Barta József , Nagy Judit
Published: April 2003

The absence of diurnal blood pressure rhythm is characteristic of patients with chronic glomerulonephritis already before they develop hypertension. The prognostic importance and possible target organ-damaging effect of the absence are unknown. Simultaneously, 24-hour ambulatory blood pressure monitoring and echocardiographic investigations were done in 12 normotensive and 38 hypertensive IgA nephropathy patients. The hypertensive patients were treated with either angiotensin-converting enzyme inhibitor (ACEI) alone or in combination with a non-dihydropyridine calcium channel blocker. The absence of a night-time blood pressure reduction was frequent in both groups (5/12 vs. 20/38). In the hypertensive patients, blood pressure and left ventricular mass index were higher (124.6 ± 23.3/81.2 ± 15.3 vs. 106.6 ± 33.4/67.4 ± 21.8 mm Hg, p < 0.001, and 124.1 ± 46.2 vs. 89.2 ± 45.6 g/m2, p < 0.01). Diastolic left ventricular function was better in normotensive patients, in whom E wave/A wave ratio (E/A) and decelaration time values correlated closely with the diastolic diurnal index (E/A, r = 0.86, p < 0.01; DT, r = –0.70, p < 0.01). In the hypertensive patients, both the left ventricular wall thickness and diastolic function were significantly related to nighttime blood pressure and diurnal index values, but there was no relationship with daytime blood pressure. In conclusion, in IgA nephropathy patients there are mild cardiac abnormalities before they develop hypertension, the abnormalities bearing the closest correlation with the decrease in diurnal blood pressure rhythm. These data suggest the inefficacy of ACEI and calcium channel blockers in treating nighttime hypertension and in reestablishing diurnal rhythm. These phenomena are of great importance in the development of left ventricular hypertrophy and diastolic malfunction.
Circulating Concentrations of Soluble Interleukin 6 Receptors gp80 and gp130 in Chronic Renal Failure and Effects ofRenal Replacement Therapy
Authors: Frieling Johan T.M. , van Hamersvelt Henk W. , Wijdenes John , Hendriks Thijs , Sauerwein Robert W. , van der Linden Cees J.
Published: April 2003

Background: Circulating receptors modulate the biological effects of cytokines. Renal insufficiency is known to influence the concentrations of the soluble tumor necrosis factor (TNF) receptors p55 and p75. No data are available on the concentrations of the circulating interleukin 6 (IL-6) receptors gp80 and gp130 during chronic renal insufficiency. Methods: We compared the serum concentrations of the IL-6 receptors gp80 and gp130 to those of the TNF receptors p55 and p75 in end-stage chronic renal failure, continuous ambulatory peritoneal dialysis, and hemodialysis (HD). Results: In healthy controls the concentrations of gp80, gp130, p55, and p75 in serum were 82.1 ± 24.3, 87.9 ± 20.2, 1.1 ± 0.2, and 1.7 ± 0.3 ng/ml, respectively. These concentrations were increased to, respectively, 112.2 ± 18.0, 186.0 ± 37.7, 10.5 ± 4.3, and 15.0 ± 7.5 ng/ml in chronic renal failure, to 138.8 ± 18.0, 181.3 ± 46.1, 25.5 ± 5.2, and 19.1 ± 3.4 ng/ml in continuous ambulatory peritoneal dialysis, and to 107.9 ± 29.4, 146.6 ± 30.5, 22.9 ± 6.3, and 16.8 ± 6.0 ng/ ml in HD (before dialysis session). The concentrations after HD were higher for p75 only. Conclusions: The data show that the concentrations of the IL-6 receptors (gp80 and gp130) are elevated in chronic renal insufficiency. The increase is relatively low as compared with the elevation of the TNF receptors in this situation. HD does not result in a consistent change in serum concentrations of the various receptors.
A Prospective Study of Hepatitis C Viremia in Renal Allograft Recipients
Authors: Mahmoud Ihab M. , Sobh Mohamed A. , Amer Galal M. , El-Chenawy Farha A. , Gazareen Sanaa H. , El-Sherif Assam , El-Sawy Esam , Ghoneim Mohamed A.
Published: April 2003

In an attempt to study the impact of HCV viremia on renal transplant clinical course and outcome, we prospectively followed 133 HBsAg-negative end stage renal disease (ESRD) patients, in whom HCV-RNA-PCR results were available, from the pre- to post-transplant period. Eighty (60%) ESRD patients tested PCR-positive, of these, 12 (15%) were anti-HCV negative by second generation ELISA. The viremic patients had a longer time on dialysis (p < 0.001), received more blood units (p < 0.001) and had a higher frequency of pre-transplantation liver disease (p < 0.001). Further, 41% of PCR-positive patients gave a history of antischistosomal treatment compared with 23% of PCR-negative ones (p = 0.048). Recipients with and without HCV viremia were followed for a mean of 31.8 ± 5.8 (range 6–42) months and 29.8 ± 9 (range 6–41) months respectively, p = 0.14. While the prevalence of HCV viremia increased from 60 to 64% at the last follow-up, the anti-HCV seroprevalence decreased from 63 to 61%. PCR-positive patients had higher rates of both acute (p = 0.005) and chronic (p < 0.001) liver disease after transplantation compared with PCR-negative patients. However, none of our HCV RNA positive recipients developed a fulminant liver disease or hepatic failure until the last follow-up. Stepwise logistic regression analysis identified pre-transplant liver disease (Odds ratio = 2.4; p = 0.07) and a cumulative corticosteroid dose in excess of 15 g at the last follow-up (Odds ratio = 3; p = 0.03) as independent predictors of post-transplant hepatic dysfunction in PCR-positive patients. Azathioprine was discontinued due to hepatic dysfunction in a significantly (p = 0.005) higher proportion of viremic patients compared with the non-viremic ones. There were no significant differences between PCR-positive and -negative patients in terms of frequencies and individual causes of graft and patient losses. Our results demonstrate that HCV infection is extremely prevalent in Egyptian hemodialysis patients and is responsible for most hepatic dysfunctions after transplantation. Although HCV viremia did not negatively affect graft or patient outcome until 31 months post-transplantation, the authors would recommend that a viremic patient should have a liver biopsy before transplantation and be immunosuppressed with caution post-transplantation. A longer follow-up may be required to exclude increased rates of HCV-induced hepatic mortalities.
Thrombotic Microangiopathy with Renal Failure in Two Patients Undergoing Gemcitabine Chemotherapy
Authors: Lhotta Karl , Kühr Thomas , Rumpelt Hans J. , Wöll Ewald , Thaler Josef , König Paul
Published: April 2003

Described here are 2 patients who developed thrombotic microangiopathy of the kidneys after receiving high cumulative doses of the new anticancer drug gemcitabine. The first patient, who received gemcitabine for treatment of a carcinoma of the pancreas, required hemodialysis for 6 months. In the second case, a woman suffering from a cholangiocellular carcinoma, end-stage renal disease was irreversible. Clinical awareness, timely detection and discontinuation of gemcitabine are mandatory to prevent this rare but disastrous complication of gemcitabine therapy.
Association of Dialyzer Reuse and Hospitalization Rates among Hemodialysis Patients in the US
Authors: Feldman Harold I. , Bilker Warren B. , Hackett Monica , Simmons Christopher W. , Holmes John H. , Pauly Mark V. , Escarce José J.
Published: April 2003

Objectives: To determine if reuse of hemodialyzers is associated with higher rates of hospitalization and their resulting costs among end-stage renal disease (ESRD) patients. Methods: Noncurrent cohort study of hospitalization rates among 27,264 ESRD patients beginning hemodialysis in the United States in 1986 and 1987. Results: Dialysis in free-standing facilities reprocessing dialyzers was associated with a greater rate of hospitalization than in facilities not reprocessing (relative rate (RR) = 1.08, 95% confidence interval (CI), 1.02–1.14). This higher rate of hospitalization was observed with dialyzer reuse using peracetic/acetic acids (RR = 1.11, CI 1.04–1.18) and formaldehyde (RR = 1.07, CI 1.00–1.14), but not glutaraldehyde (p = 0.97). There was no difference among hospitalization rates in hospital-based facilities reprocessing dialyzers with any sterilant and those not reprocessing. Hospitalization for causes other than vascular access morbidity in free-standing facilities reusing dialyzers with formaldehyde was not different from hospitalization in facilities not reusing. However, reuse with peracetic/acetic acids was associated with higher rates of hospitalization than formaldehyde (RR = 1.08, CI 1.03–1.15). Conclusions: Dialysis in free-standing facilities reprocessing dialyzers with peracetic/acetic acids or formaldehyde was associated with greater hospitalization than dialysis without dialyzer reprocessing. This greater hospitalization accounts for a large increment in inpatient stays in the USA. These findings raise important concerns about potentially avoidable morbidity among hemodialysis patients.