bluuebunny/crossref_metadata_2025 huggingface dataset:
Il Trattamento Chirurgico Resettivo Del Carcinoma Pancreatico
Authors: Magistrelli Paolo , Antinori Armando , Crucitti Antonio , La Greca Antonio , Coppola Roberto , Nuzzo Gennaro , Picciocchi Aurelio
Published: April 2018

Aims and background

Surgical resection offers the only potential cure for pancreatic carcinoma. Although the overall prognosis remains a dismal, several recent series have reported an encouraging increase in 5-year survival after resection, ex-ceding 20%. As the reasons for this improvement are not clearly understood, numerous clinico-pathological parameters (demographic, intraoperative and histopatologic factors) have been investigated to evaluate their role in predicting long term survival. In this single-institution study, immediate and long-term outcome after pancreatic resection in patients with pancreatic adenocarcinoma was retrospectively evaluated, focusing attention on the possible impact of different clinico-pathologic factors on long-term survival.

Methods

Sixty-six patients with a confirmed histologic diagnosis of adenocarcinoma of the pancreas, treated by pancreatic resection at the Department of Surgery of the Catholic University of Rome in the years 1988-1997, were retrospectively analyzed. Morbidity and survival data were reviewed and potential prognostic factors were compared statistically by univariate analysis.

Results

There was no postoperative mortality. Twenty-five patients (38%) developed major operative complications. Pancreatic fistula was the most common complication, and occurred in 7 patients (11%). The actuarial overall and disease-specific survival for all 66 patients were respectively 58% and 59% at 1 year, 27% and 31% at 3 years, and 13% and 20% at 5 years, with a median survival time of 13.4 months. Nodal status was the only single factor significantly affecting survival by univariate analysis. The 3-and 5-year survival rates were respectively 35% and 19% for node-negative patients and 7% and 0% for node-positive patients (P = .04). A positive correlation with improved survival, even if not of statistical significance, was shown for other pathologic or intraoperative factors. Among the former, 5-year survival rates were better for patients with negative resection margins as compared to patients with positive margins (12% vs 7%, P = ns). Among the latter, a better actuarial 5-year survival rate was shown for patients with shorter operative time (<4 hours, 21% survival vs >4 hours 5%, P = ns) and for patients that received fewer transfusions (0-2 blood units, 14% survival vs 3 or more blood units, 0%; P = ns). Age, gender, tumor diameter and tumor grading showed no influence on survival in this series.

Conclusions

Our series confirmed that nodal status is the strongest independent predictor of survival. Limited intraoperative transfusion, reduced operative time and clear margins could also yeald a prognostic significance, and require further confirmation in larger series.
La Radiochemioterapia Preoperatoria Del Carcinoma Pancreatico: Risultati Preliminari
Authors: Morganti Alessio G. , Trodella Lucio , Valentini Vincenzo , Doglietto Giovan Battista , Ziccarelli Pierpaolo , Macchia Gabriella , Alfieri Sergio , Smaniotto Daniela , Luzi Stefano , Brizi M. Gabriella , Fadda Guido , Fiorino Marilena , Di Gesù Cinzia , Cellini Numa
Published: April 2018

Aims and background

The prognosis of pancreatic cancer remains poor. Surgery, when feasible, is rarely curative. Radiation therapy (RT) and concomitant 5-fluorouracil (5-FU) have been shown to improve survival in locally advanced pancreatic cancer. In an attempt to improve resectability and disease control, we used preoperative chemoradiation in a combined modality therapy protocol. The purpose of this study was to evaluate our initial results in terms of acute toxicity and response.

Methods

From October 1995 to May 1998, 20 patients (11 males, 9 females; mean age, 60.1 years; median follow-up, 28 months) with unresectable (12 patients) or resectable (8 patients) non-metastatic pancreatic tumors, received external beam radiation (39.6 Gy) plus 5-FU (96 hours continuous infusion, days 1-4 at 1000 mg/m2/day). After 4 weeks, patients were evaluated for surgical resection. In resected patients, electron-beam intraoperative radiation therapy (10 Gy) was given before reconstruction. Thereafter, in resected patients, adjuvant chemotherapy was prescribed (6 courses: 5-FU, mitomycin C, adriamicine).

Results

During chemoradiation, no patients developed grade 3-4 acute toxicity. Three out of twelve (25%) patients with unresectable tumors had tumor downstaging. No patients showed partial or complete responses. Four out of twenty patients (20%) had minimal tumor response. Three patients showed disease progression after chemoradiation (liver or peritoneal metastases). Nine patients underwent surgical resection and IORT, with 1 postoperative death. The median survival time for the 20 patients was 9.4 (18.5 and 8.3 months in resected and unresected patients, respectively).

Conclusion

Our preliminary results suggest that preoperative 5-FU chemoradiation was well tolerated and may result in tumor downstaging but the response-rate is still low. Based on the impact of surgical resection on survival, an improvement in local response rate is necessary.
La Radioterapia Intraoperatoria Nel Trattamento Integrato Del Carcinoma Pancreatico
Authors: Fellin Giovanni , Pani Giuseppe , Tomio Luigi , Tirone Giuseppe , Eccher Claudio
Published: April 2018

Pancreatic cancer is a highly lethal disease either for the high incidence of distant metastases or for the frequent local recidive also after potentially curative resection. For this reason new multimodality approaches have to be investigated. Intraoperative radiotherapy (IORT) permits to administer a high dose to the tumor or to the retropancreatic tissues and to the regional lymphnodes. Literature data suggest it is possible a better local control and pheraps a better survival than the surgery alone or the palliative treatments by the use of schedules with IORT. Anyway they are retrospective data and IORT is an investigational method which has to be indagate in the combined modality approaches to this disease.
Possibilità Di Palliazione Nel Carcinoma Pancreatico
Authors: Di Costanzo Francesco , Sdrobolini Andrea , Gasperoni Sandra
Published: April 2018

Adenocarcinoma of the pancreas is the cause of 3-4% of cancer related deaths in Italy and over 80% of all patients exhibit advanced disease. Treatment with surgery and chemio-radio-therapy may have meaningful results in resectable and locoregional tumours respectively.

Chemotherapy is the treatment of choice in metastatic disease as palliative intent, although pancreatic tumour is considered resistant to treatment with conventional cytotoxicity drugs.

Assessment of response of primary tumor is extremely difficult because of its anatomical location and fibrotic reaction around the tumor. Furthermore, medical problems associated with the age of patients, reduced performance status (PS), malnourished conditions, jaundice and pain, limit patients’ tolerance and response to chemotherapy.

5-fluorouracil (5-FU) is the most frequently used drug in the treatment of pancreatic cancer with a RR of 28% in the trials performed in mid 1980, while more recently studies have reported a RR of 5-15%.

Biochemical modulation of 5-FU by leucovorin, PALA and interferon does not appear to produce better results than 5-FU alone.

5-FU-based combination chemotherapy (FAM, SMF, etc) have shown interesting results in phase II (30-40%), but in a randomized trial the results of combination were similar to 5-FU alone (<15%). Also, regimens containing platinum gave disappointing results just as the other combinations and cannot be recommended outside prospective clinical trials.

When chemotherapy was compared to best supportive care (BSC), the results demonstrated a survival gain. Six studies, comparing chemotherapy versus BSC and 3 trials showed statistically significant difference in survival for patients treated with chemotherapy.

Recently, new drugs have been introduced in the treatment of gastrointestinal tumour (gemcitabine, CPT11, raltitrexed, tax-anes, etc.). Gemcitabine is a novel nucleoside analogue that has shown a very favourable toxicity profile and RR of 10-15% in advanced pancreatic cancer. Data from a phase II and randomized comparative trials suggest that gemcitabine offers an advantage over 5-FU in terms of improvement of PS and general clinical symptoms.

Given the difficulty of accurate tumor measurement in this disease, some authors introduced a novel new end-point to evaluate the response: clinical benefit (CB).

In a randomized trial of gemcitabine vs 5-FU, RR using CB was 23.8 with gemcitabine and 4.8 with 5-FU, this difference was statistically significant with a median survival of 5.6 and 4.4 months, respectively.

In conclusion, future studies should focus on phase III trials with gemcitabine, alone or in combination and phase II with new promising drugs. Quality of life, pharmaco-economic studies, CB should be the principal end-point of these studies.

All patients with advanced pancreatic cancer should be included in clinical cooperative trials.
Low 1-Year Return-to-Sport Rate After Anterior Cruciate Ligament Reconstruction Regardless of Patient and Surgical Factors: A Prospective Cohort Study of 272 Patients
Authors: Hamrin Senorski Eric , Svantesson Eleonor , Beischer Susanne , Thomeé Christoffer , Thomeé Roland , Karlsson Jón , Samuelsson Kristian
Published: April 2018

Background:

There is insufficient knowledge about the way that concomitant injuries affect the short-term likelihood of a return to a knee-strenuous sport after anterior cruciate ligament (ACL) reconstruction.

Hypotheses/Purpose:

The purpose was to study whether patient characteristics, concomitant injuries, and graft choice at primary ACL reconstruction can predict return to sport (RTS) 1 year after surgery. The hypotheses were that younger age at the time of ACL reconstruction would positively affect RTS, while the presence of concomitant injuries would negatively affect RTS 1 year after surgery.

Study Design:

Case-control study; Level of evidence, 3.

Methods:

Data were extracted from a rehabilitation-specific register and the Swedish National Knee Ligament Register. Twelve months after surgery, all patients were evaluated for RTS via the Tegner Activity Scale. The primary outcome was a return to knee-strenuous sport, defined as a Tegner Activity Scale ≥6. Univariable and multivariable logistic regression analyses were performed with patient characteristics, concomitant knee injuries, and graft choice as independent variables.

Results:

A total of 272 patients (51% female) with a mean ± SD age of 25.0 ± 9.2 years were included. In the multivariable analysis, a favorable odds ratio (OR) for returning to sport was found for patients of male sex (OR, 2.58; 95% CI, 1.43-4.65; P = .0016), younger age at the time of ACL reconstruction (OR, 2.32; 95% CI, 1.59-3.33; P < .0001), a higher preinjury score on the Tegner Activity Scale (OR, 1.45; 95% CI, 1.13-1.87; P = .0038), and an absence of injury to the meniscus (OR, 1.92; 95% CI, 1.10-3.36; P = .023) and medial collateral ligament (OR, 7.61; 95% CI, 1.42-40.87; P = .018). In addition, the absence of cartilage injury was favorable in terms of RTS in the univariable analysis (OR, 2.48; 95% CI, 1.40-4.39; P = .0018).

Conclusion:

Positive predictors of a return to knee-strenuous sport 1 year after ACL reconstruction were male sex, younger age, a high preinjury level of physical activity, and the absence of concomitant injuries to the medial collateral ligament and meniscus.
The Conflict between Anticoagulation and Hemostasis during Hemodialysis
Authors: Vogel G.E. , Kopp K.F.
Published: April 2018

Anticoagulation with comparatively small amounts of heparin has been carried out in more than 3,000 acute and chronic hemodialysis procedures without problems. In a selected high risk group of postoperative and polytrauma patients no patient hemorrhages have occurred, nor have there been any clotting problems in the dialyser circuit.

Studies to elucidate the underlying mechanisms of coagulation and anticoagulation in the extracorporeal environment have been performed.

Minimal intermittent heparin administration based on plasmatic anticoagulation monitoring with the APTT method, has proven to be particularly safe.
High Density Tissue Culture on Microporous Membranes Perfused by Blood: Report of a New Bioartificial System
Authors: White D.C. , Kolobow T. , Bowman R.L.
Published: April 2018

A new tissue culture system has been developed to sup-port high density cell growth using the sheep as the host. Cellular nutrition is provided by plasma solutes as they diffuse from arterial blood across microporous polycarbonate membranes into a device attached to an arteriovenous shunt. Culture chambers are constructed with transparent polycarbonate to allow photomicroscopy of the tissue in situ. System performance is demonstrated by the high density growth of fetal sheep thymus allografts and rat soft tissue sarcoma xenografts.
Blood Purification Treatment of Schizophrenia
Authors: Nedopil N. , Dieterle D. , Gurland H.-J.
Published: April 2018

In order to gather information about the usefulness of blood purification methods as a treatment for chronic schizophrenic patients, «mini-questionnaires» were sent to all European centers working with this method. The questionnaires consisted of two parts, one asking the psychiatrist about the disease itself and the evaluation of treatment, the other one asking the nephrologist about the specific method used. –- A preliminary report, based on the evaluation of 53 questionnaires indicated –- although far from offering conclusive results –- that all schizophrenic patients did not profit equally from the therapy and that patients treated for less than 6 hours per week were not likely to improve. Implications for further research are discussed.
Old, new and Revised Aspects of Artificial Organs
Authors: Kolff W.J.
Published: April 2018

Retrograde perfusion of the coronary veins with oxygenated blood is effective. Closed chest transarterial left ventricular bypass was developed by Hans Zwart to support the failing left ventricle. Transapical left ventricular bypass started by Alex Kralios, later studied by Jeffrey Peters et al, became effective when filters were introduced into the system –- first surviving patient! One must be prepared to support both ventricles. Retrograde transpulmonary bypass (Kralios) is as yet only experimental. The blood is pumped from one occluded pulmonary artery into the aorta. Plasmapheresis removes particles with a molecular weight of 7 to 45,000 which may be harmful in patients with burns or oxygenators since they blind the leukocytes. Starling's Law will regulate the total artificial heart. The future is for the electrohydraulic artificial heart by Robert Jarvik. However, air driven hearts may offer a life of sufficient quality to people now doomed to die. All types of hemodialyzers or peritoneal dialyzers should be made portable or wearable. The «mouse» is a good peritoneal access device. It makes recirculating peritoneal dialysis practical.
Late Results of Replacement of Cardiac Valves by Dura-Mater Allografts
Authors: Stolf N.A.G. , Puig L.B. , Zerbini E.J.
Published: April 2018

Homologous dura-mater valve was employed in a series of 2.338 patients in the period between January 1971 and January 1979. A restricted group of the first 272 patients were followed-up from six to eight years. This study showed gratifying results following mitral and tricuspid valves replacement and not as satisfactory results after aortic replacement. The postoperative complications were, for mitral valve: fungal endocarditis (0.68%), bacterial endocarditis (2.56%) thromboembolism (1.36%) valve dysfunction (12.9%) and reoperation was performed in 5.12% of the cases. For aortic valve replacement there was fungal endocarditis in 1.36% of cases, bacterial endocarditis in 5.68%, valve dysfunction in 29.54% and the incidence of reoperation was 23.28%. No anticoagulants were employed in this series.
Analysis of Possible Toxins in Hepatic Coma Including the Removal of Mercaptan by Albumin-Collodion Charcoal
Authors: Chang T.M.S. , Lister C.
Published: April 2018

Albumin-collodion coated activated charcoal was found to effectively remove mercaptan in aqueous solution or in «plasma» solution. An initial clearance of 150 ml/min at a flow rate of 200 ml/min could be obtained. The roles of middle molecules, loosely protein-bound molecules, phenols, mercaptan and other molecules were discussed.
Immobilization and Characterization of L-Asparaginase on Hollow Fibers
Authors: Mazzola G. , Vecchio G.
Published: April 2018

L-Asparaginase was immobilized with various methods: cyanogen bromide, cyanuric chloride and cross-linking with glutaraldehyde.

A dialysis device was transformed in a bioreactor with the enzyme immobilized on the outer surface of hollow fibers.

Results on kinetic behavior, stability in storage and lyophilization are reported.
Regular Hemoperfusion in Regular Dialysis Treatment. A Long-Term Study
Authors: Stefoni S. , Colì L. , Feliciangeli G. , Baldrati L. , Bonomini V.
Published: April 2018

The capacity of activated charcoal to remove toxins from the blood is well established. Its poor biocompatibility, inability to remove urea, electrolytes and water, and high cost have so far been the major objection to a wider use of charcoal with chronic uremic patients.

The availability of a charcoal coated by a new highly hydrophilic methacrylate based membrane enabled us to keep 18 uremic patients on a combined hemodialysis-hemoperfusion schedule for 4–52 weeks. Investigations concerned patients in whom relapsing signs of uremia occurred despite technically adequate dialysis, and other cases where dialysis was both technically and clinically adequate. In the first group of patients, the conbined programme led to an improvement of the dialysis resistent clinical signs, while certain positive metabolic effects were also observed. In the second group, the hemodialysis-hemoperfusion treatment allowed a reduction of about 30% in time of treatment per week.

Tolerance of the new coated charcoal was good throughout treatment in terms both of biocompatibility and of side effects.
Infectious Peritonitis. The Main Complication of Intermittent Peritoneal Dialysis
Authors: Andersen K.E. Hemmeløff , Kolmos H.J.
Published: April 2018

Infectious peritonitis was studied in 164 patients with renal failure receiving 24, 282 peritoneal dialyses over a five-year period. One hundred and fifty nine episodes were registered in 93 patients. The overall incidence was 0.66 episodes per 100 dialyses. Two epidemics accounted for a higher incidence during the first half of the study, while the incidence of endemic peritonitis remained unchanged. Infectious peritonitis was the most common complication among out-patients and was the cause of drop out in 39 per cent of the patients transferred to haemodialysis. The calculated mortality from peritonitis was 0.08, corresponding to one fifth of all deaths. The case fatality rate was 0.14. The most common aetiological microorganisms were Staphylococcus aureus and micrococci, accounting for 50 per cent of the cases. Forty six per cent of the cases caused by Staphylococcus aureus were preceeded by wound or catheter tunnel infections with the same strain. This points to the abdominal skin flora as the main source of endemic peritonitis. However, further epidemiological studies are needed to elucidate how the skin saprophytes reach the peritoneal cavity.
Soluble Liver Extract as Supplement to Detoxification by Hemoperfusion in Liver Failure
Authors: Dixit V. , Chang T.M.S.
Published: April 2018

Charcoal hemoperfusion has been effective in reversing grade IV hepatic encephalopathy in patients. In animal studies essential factors have to be added to result in significant increase in the survival rate of grade III coma rats treated by hemoperfusion. In the present study, a water soluble liver extract was prepared and injected intraperitoneally into fulminant hepatic failure rats in grade II hepatic coma. This significantly (p < 0.001) increased the survival time in these animals. However, no significant increase in survival rate was obtained. We were also able to significantly (p < 0.0005) control gastrointestinal bleeding in the treated rats. We postulate that this supplementation of essential factors in combination with detoxification using hemoperfusion could form the basis of a more complete artificial liver support system.
Modulatory Role of Gamma-Aminobutyric Acid (GABA) in the Regulation of Gonadotropin Secretion in Patients with Chronic Renal Failure
Authors: Elias A.N. , Pahl M. , Stone S. , Vaziri N.D. , Valenta L.J.
Published: April 2018

The role of gamma-aminobutyric acid (GABA) in the regulation of gonadotropin secretion in renal failure, was studied in 5 patients with chronic renal failure who were on maintenance dialysis. Di-n-propylacetic acid (valproic acid-VA), a GABA-transaminase inhibitor which has been shown to increase brain GABA levels, was used in the study.

VA produced no significant change in the basal serum LH and FSH concentrations, or in E2 or T concentrations in the renal failure patients, or the E2 and P concentrations in normal controls, but augmented the Δ LH (maximum increment above baseline) and Δ FSH response to LHRH. Δ LH rose from 30.4 ± 12.7 mlU/ml ([Formula: see text]) to 41.1 ± 16.8 mlU/ml (p < 0.01) after VA, while Δ FSH rose from 2.8 ± 1.8 mlU/ml to 3.8 ± 1.6 mlU/ml (p < 0.05). The findings support a modulatory role for GABA in gonadotropin secretion in chronic renal failure.
«Physiological» and «Pharmacological» Dialysate Sodium Concentrations
Authors: Locatelli F. , Pedrini L. , Ponti R. , Costanzo R. , Di Filippo S. , Marai P. , Pozzi C. , Bonacina G.P.
Published: April 2018

Forty three uremic patients on regular hemodialysis treatment (4 hours 3 times/week) were dialyzed for a period of 28.95 ± 14.46 months with a dialysate sodium concentration (NaD) of 142 mEq/l, similar to their plasma water sodium concentration corrected for the Donnan factor («physiological» NaD). Blood pressure (BP) and body weight (BW) dropped significantly.

During two following periods, lasting 18 and 14 months, with NaD 148 mEq/l, similar to the patients’ plasma water sodium concentration («pharmacologically high» NaD), cardiovascular stability improved and BP did not show significant increase.

Using «physiological» and «pharmacologically high» NaD the removal of water and sodium by convection improves the cardiovascular stability and the patients’ well being, without bringing about the feared long-term cardiovascular side effects, if an appropriate dry body weight is achieved, because of better correction of the cellular overhydration.
In Vitro Adsorption of Oxalic Acid and Glyoxylic Acid onto Activated Charcoal, Resins and Hydrous Zirconium Oxide
Authors: Scholtens R. , Scholten J. , de Koning H.W.M. , Tijssen J. , ten Hoopen H.W.M. , Olthuis F.M.F.G. , Feijen J.
Published: April 2018

Patients suffering from primary hyperoxaluria show elevated plasma concentrations of oxalic acid and glyoxylic acid. The in vitro adsorption of these compounds onto activated charcoal, a series of neutral and ion exchange resins and onto hydrous zirconium oxide has been investigated. Hydrous zirconium oxide was the most effective sorbent studied for the removal of both oxalic acid and glyoxylic acid. In batch experiments, the zirconium oxide was capable of binding 5.5 μ mol oxalic acid and 8 μ mol glyoxylic acid per gram sorbent using 0.5 gram sorbent and 50 ml of solutions with initial concentrations of 100 μ mol. L−1 and an ionic composition resembling that of plasma. Recirculation of 2 L of the same solutions through 12 gram of a mixture of hydrous zirconium oxide and alumina for 6 hours at a flow rate of 12 ml.min−1, resulted in a final concentration of 70 μ mol. L−1 of oxalic acid and 50 μ mol. L−/ of glyoxylic acid.
Hemodialysis without Anticoagulants in Patients with High Bleeding Risk
Authors: Casati S. , Graziani G. , Ponticelli C.
Published: April 2018

Twenty hemodialysis were performed in six uremic patients with high bleeding risk, with a technique avoiding any anticoagulant drug before or during the treatment.

The treatment was well tolerated in all patients and no alterations were observed in the intrinsic clotting system evaluated before, during and after hemodialysis.

During the study, devices were never lost because of clotting or rupture, and their performances were similar to those obtained on heparin hemodialysis.

We suggest that in critically ill patients, needing dialysis, hemodialysis without heparin is possible and safe.
Effects of Charcoal Hemoperfusion with Prostacyclin on the Coagulation-fibrinolysis System and Platelets of Patients with Fulminant Hepatic Failure — Preliminary Observations
Authors: Cordopatri F. , Boncinelli S. , Marsili M. , Lorenzi P. , Fabbri L.P. , Paci P. , Salvadori M. , Morfini M. , Cinotti S. , Casparini P.
Published: April 2018

The coagulation-fibrinolysis system and platelet function were studied in two patients with fulminant hepatic failure undergoing charcoal hemoperfusion with prostacyclin (PGI2) infusion. There was no adverse effect on the purely coagulative side and significant decreases were found only in Factors V and VII. There was a significant increase in platelet count and initially high BTG values decreased to normal. The findings suggest that PGI2 greatly improves the biocompatibility of hemoperfusion devices.
Histological Reactions of Porous Tip Endocardial Electrodes Implanted in Sheep
Authors: Guarda F. , Galloni M. , Assone F. , Pasteris V. , Luboz M.P.
Published: April 2018

The tissue reaction caused by a sintered tip electrode is compared with that of a platinum-iridium tip electrode in a work which employs implantation in sheep and follow-up of the implant for up to 90 days. Clinical tests and anatomo-pathological examination of the histological sections were performed.

The results show a remarkably rapid fixation to the heart for the porous electrode with formation of limited inflammatory process, a thin fibrous capsule and modest alteration of the endocardial tissue. Conversely, the platinum-iridium electrode does not fix even in long periods and therefore continously rubs the endocardial surface.

Chronic inflammation and formation of remarkably thick connective capsule results, under which the heart seems mode deeply altered.
Hydrodynamic and Rejection Properties of a Coil Dialyzer
Authors: Klein E. , Williams T. , Feldhoff P. , Wendt R.P.
Published: April 2018

Compliance of coil dialyzers follows a linear dependence on pressure when measured in saline; compliance measurements with non-wetting fluids are inappropriate and underestimate the blood compartment expansion experienced with pressure. The arithmetic mean of inlet and outlet pressures can be used to predict ultrafiltration rate independent of venous outlet pressure, and blood compartment volume varies both with inlet pressure and blood flow. The rejection of carbohydrate marker solutes increases from about 10% for 1,200 Daltons to 100% for 12,000 Dalton species.
Interrelationships between Blood Pressure, Blood Gases and Plasma Acetate Concentrations during Conventional Hemodialysis
Authors: Cannella G. , Cancarini G. , De Marinis S. , Maccagnola V. , Tosoni S. , Cristinelli L. , Maiorca R.
Published: April 2018

To determine to what extent the intradialysis changes in blood pressure (BP) are related to the variations in blood gases and plasma acetate concentrations (plAc), 11 dialysed uremics were studied with measurement of plAc, pH, pCO2 and pO2 every 60’ during a hemodialysis lasting 4 hrs. Dialysis resulted in significant decreases in the BP, pO2 and pCO2 and in significant increases in pH and plAc. Multiple regression analysis demonstrated that the Δ% for the mean BP was closely related to plAc, pCO2 and Δ− % of body weight (BW). Partial regression coefficient indicated the following rank order of correlation: plAc > pCO2 ≥ Δ−% BW > pO2 = O, thus demonstrating that the fall in blood pressure is related both to the increase in plAc and the decrease in pCO2.

The physiological relevance of these relationships is discussed. The hypothesis is advanced that the pCO2 decrease during dialysis might contribute to the acetate-induced vascular instability.
The Adsorption of Bilirubin from Aqueous Solution onto Solid Cholestyramine and Polyvinylpyrrolidone
Authors: Henning D.S. , Brown G.R. , St-Pierre L.E.
Published: April 2018

Shifts in the visible spectrum of aqueous bilirubin (BR) resulting from the addition of soluble polyvinylpyrrolidone (PVP) suggest specific interactions. Hence, isotherms were determined for the adsorption of BR from aqueous solution onto solid, cross-linked PVP and onto cholestyramine (CA) (used as a reference adsorbent) at 0, 10, 20 and 25°C. Although adsorption onto PVP reaches equilibrium values more rapidly than for CA, the latter adsorbent has a larger capacity. Furthermore the isotherms for PVP are independent of temperature while those for CA show an increase in BR adsorbed with an increase in temperature.
CAPD + Hemoperfusion Once a Week in the Management of Children with End-stage Renal Disease
Authors: Capodicasa G. , De Santo N.G. , Vaccaro F. , Manzo M. , Maione S. , Capasso G. , Giordano C.
Published: April 2018

With hemoperfusion there is a sharp decline in the solute concentration of the blood compartment, but immediately after HP the concentration of these substances rises to the original level (post-Hp rebound). It may be inferred that the result would be better and the rebound phenomenon less marked if hemoperfusion could be combined with a continuous dialysis system such as CAPD.

The study was performed in 3 children of our CAPD programm. All patients were dialysed with 5 daily exchange each of one liter.

The patients underwent at 2-hours hemoperfusion with a charcoal column (Gambro Adsorba 150 c) once a week.

The data obtained with this form of treatment are indicative for a: significant increase of weekly clearance for uric acid and creatinine. low urea generation rate far 1–3 days after HP. low post-Hp rebound and reduced platelet count but not platelet activation.
Haemodialyser Reuse: Impact on Function and Biocompatibility
Authors: Hoenich N.A. , Johnston S.R.D. , Buckley P. , Harden J. , Ward M.K. , Kerr D.N.S.
Published: April 2018

The functional performance (clearance of small molecules, ultrafiltration and blood loss) and biocompatibility (haemodialysis leucopenia) has been studied for disposable flat plate and hollow fibre haemodialysers utilizing Cuprophan membranes on their first use, and compared with that obtained when reusing by a manual and automated technique. The results obtained relating to functional performance remain unchanged with the exception of blood loss which shows an increase compared with first use. Biocompatibility is modified on reuse but only if the membrane has not been exposed to a rinsing process using sodium hypochlorite.
In Vitro adsorption Spectrum of Plasma Amino Acids by Coated Charcoal Hemoperfusion
Authors: Shi Z.Q. , Chang T.M.S.
Published: April 2018

In order to clarify wether coated charcoal hemoperfusion is capable of normalizing amino acid disturbances in hepatic coma, in vitro adsorption and in vitro hemoperfusion studies were carried out. We have found that collodion-coated activated charcoal beads preferentially removed much more aromatic acids (AAA) than branched chain amino acids (BCAA). In the in vitro adsorption experiment with 50 μM amino acid standards aqueous solution, 99% of AAAs were removed by charcoal while only 50 to 81% of BCAAs were removed. As the concentration of amino acids in solution was doubled from μM to 100 μM, BCAA removal was halved while about 90% of AAA was still being removed. In vitro hemoperfusion with heparinized blood from hepatic failure rats, the clearance and the removal of AAAs were significantly greater than those of BCAAs. Consequently, the molar ratio of BCAA over AAA was markedly improved from the initial 1.09 to 3.87 after 60 min of hemoperfusion. Thus, we have demonstrated the preferential adsorption of aromatic amino acids by collodion-coated charcoal beads. The correction of BCAA/AAA molar ratio is also demonstrated.
Polyacrylonitrile Hemofiltration for the Adsorption Myoglobin in Tardy Revascularization Syndrome: In Vitro Assessment
Authors: Cavicchioni C. , Ceriati F. , Marino I.R. , Marta M. , Pomponi M. , Vernole P.
Published: April 2018

The Authors examine the behavior of P.A.N. membranes hemoperfusion combined with district hemodialysis in the prevention of tardy revascularization syndrome. Their experience “in vitro” seems to confirm the use of P.A.N. membrane is advisable whenever an increase of the myoglobin concentration occurs and they also envisage the use of the P.A.N. membrane in the prevention of T.R.S.
Middle Molecules in the Serum, Brain, Liver and Urine of Galactosamine-Induced Fulminant Hepatic Failure Rats
Authors: Shu C.D. , Chang T.M.S.
Published: April 2018

The middle-molecular weight compounds in the serum, liver, brain and urine were determined in normal and galactosamine-induced grade III coma fulminant hepatic failure (FHF) rats. Peak 7 and subpeak 7g middle molecules increased significantly in the serum of hepatic coma rats. In the brain of grade III coma FHF rats, subpeak 7g increased significantly but peak 7 and other subpeaks decreased significantly. In the liver and urine, both peak 7 and subpeak 7g decreased significantly in grade III coma FHF rats. This rather specific increase of subpeak 7g in the brain corresponding to the increase of subpeak 7g in the serum may contribute to further understanding of the role of middle molecules in hepatic coma.
Problems of CAPD: Progress of the 4 years’ experience
Authors: Cancarini G.C. , Brasa S. , Camerini C. , Maiorca R.
Published: April 2018

Results of four years’ experience of CAPD in our Centre are reported. The incidence of peritonitis in 13 patients dropped with the use of Y-set from 1/4 patient-months to 1/26 p-m).

As experience was gained we reduced the use of hypertonic bags and improved diet suggestions. By these interventions during the past year, we obtained a good control of triglycerides and cholesterol concentration and a reduction in weight gain.
Body Fluid Spaces in Patients on CAPD
Authors: Panzetta G. , Guerra U. , D'angelo A. , Sandrini S. , Terzi A. , Oldrizzi L. , Maiorca R.
Published: April 2018

Total body water (TBW) and extracellular water (ECW) were determined in 9 CAPD patients on treatment from 5 to 14 months (mean 8.6 months).

The mean value of TBW was normal and directly correlated to body weight, but TBW was abnormally distributed between extracellular and intracellular space. ECW volume was significantly lower than the predicted value (12.1 ± 1.4 I versus 16.8 ± 1.9 I) and out of proportion to TBW (34.8 ± 3.9% versus 47.8 ± 1.5%). The calculated ICW, therefore, appeared clearly hyperexpanded.

The data suggest that cell overhydration was the distinctive feature in our CAPD patients.
Control of Uremic Neuropathy by Equilibrium Peritoneal Dialysis
Authors: Buoncristiani U. , Mazzotta G. , Carobi C. , Gallai V. , Cozzari M. , Di Paolo N. N.
Published: April 2018

Motor nerve conduction velocity (MNCV), sensory nerve conduction velocity (SNVC) and distal motor latencies times (DMLT) were evaluated both in upper and lower limbs in three groups of 15 patients of comparable age, treated respectively by extracorporeal dialysis (HD), continuous ambulatory peritoneal dialysis (CAPD) and combined peritoneal dialysis (CPD) for comparable sufficiently long periods. Moreover, MNCV was monitored longitudinally in two groups of patients shifted from CAPD to HD and vice versa. The results show a significant superiority of peritoneal dialysis and particularly of CAPD with respect to HD in controlling uremic neuropathy.
The role of Neurotransmitters in the Genesis of Uremic Encephalopathy
Authors: Biasioli S. , D'andrea G. , Chiaramonte S. , Fabris A. , Feriani M. , Ronco C. , Borin D. , Brendolan A. , La Greca G.
Published: April 2018

To classify the influence of neurotransmitters in the genesis of uremic encephalopathy we studied cerebrospinal fluid (CSF) and plasma (P) amino acid (AA) concentration, in patients undergoing various dialytic treatments (hemodialysis = HD, intermittent and continuous peritoneal dialysis = IPD and CAPD).

HD causes a significant decrease in CSF/P ratios of branched chain AA (BCAA) and a significant increase in CSF Glycine/Valine ratio, suggesting an augmented brain uptake of Glycine at detriment of Valine. In IPD the general trend of Aromatic AA/BCAA ratio suggests a preferentilal transport of Aromatic AA through the blood brain barrier. The differences between IPD and HD are confirmed by data concerning metabolites of Serotonin and Dopamine: CSF concentrations of 5-Hydroxyndoleacetic acid and Homovanillic acid are low in HD but high in IPD.

So, a reduced (in HD) and an increased (in IPD) activity of monoamine systems could be at the basis of some neurological disturbances appearing in uremia.
Kinetics of the Redistribution Phenomenon after Extracorporeal Elimination
Authors: Keller F. , Offermann G. , Scholle J.
Published: April 2018

Evaluation of the efficiency of extracorporeal elimination is rendered difficult by the rebound phenomenon which may occur in plasma concentrations after hemodialysis, hemoperfusion, or plasma exchange. The term clearance, derived from the extraction rate, has the drawback that it is often based on the incompatible terms plasma concentration and blood flow. To avoid these difficulties, clearance may be calculated from kinetics of plasma concentrations. But this approach will lead to an overestimation of the eliminative efficiency, because plasma concentrations may decline faster than tissue levels, which will be indicated by the rebound phenomenon.

The rebound is due to a redistribution from tissue into plasma and follows 2-compartment kinetics. However, the amount removed by extracorporeal elimination reflects the redistribution phenomenon and, simultaneously, can be used to evaluate the absolute efficiency. The amount removed can be derived from 1-compartment kinetics if redistribution can be neglected, and from 2-compartment kinetics if a redistribution takes place.

The amount removed can also be evaluated using model- independent approaches, which may be applied even if sustained absorption or proliferation must be assumed.

According to these approaches, the removed amount is given by graphic extrapolation, and it can be calculated from extracorporeal clearance and from concentrations in the removed fluid, or it can be eluted from the extracorporeal device.
A New Operational Principle for Blood Treatment with Highly Permeable Membranes
Authors: Sigdell J.E.
Published: April 2018

Conventional membrane devices for blood treatment have traditionally been operated either as hemofiiters or as dialyzers. This article discusses the possibility of combining both aspects in one single device, using a single membrane with a high hydraulic permeability. In fact, the combined function is found to be the only possible mode of operation, using very permeable membranes, but this apparently has so far not been recognized in actual application.
Amino Acid Disturbances in Experimental Hepatic Coma Rats
Authors: Shi Z.Q. , Chang T.M.S.
Published: April 2018

In our previous paper (1), we discussed the in-vitro adsorption spectrum of plasma amino acids by coated charcoal hemoperfusion. We now describe the general amino acid disturbances in plasma, CSF and cerebrum in the galactosamine induced hepatic coma model in rats. All aromatic amino acids (AAA) increased significantly in the three compartments studied. Branched chain amino acids (BCAA) were either elevated to a much lesser extent or remained unchanged. The molar ratio of BCAA:AAA was consequently reduced. This is similar to findings in fulminant hepatic failure in human and other animal models. Most of the 20 amino acids analyzed were increased significantly in the plasma. Increases of amino acids were minimal in the brain tissue studied, i.e. the cerebrum.
Effect of Charcoal Hemoperfusion on Amino Acid Disturbance in Experimental Hepatic Coma
Authors: Shi Z.-Q. , Chang T.M.S.
Published: April 2018

Using the galactosamine induced hepatic coma rat model, we studied the effects of coated charcoal hemoperfusion on amino acids in plasma and CSF in grade III hepatic coma. We found that 1 hour of hemoperfusion significantly reduced AAAs and BCAAs in plasma and increased the molar ratio of BCAA:AAA. When rats in grade III coma were treated with 2 consecutive 1-hour hemoperfusions, the substantial reduction of plasma AAAs resulted in a significant decrease of AAA levels in CSF.
Sedimentation Theory and Practical Considerations for the Design of Centrifugal Blood Cell Processes
Authors: Van Wie B.J. , Sofer S.S.
Published: April 2018

This is the first of a five-part series discussing the basic conceptualization and evaluation of techniques for centrifugal separation of blood cells. In this paper, the basic concepts of sedimentation theory will be discussed. The next two papers will discuss the effects of plasma recycle and stagewise separations, respectively, as applied to continuous-flow and semicontinuous-flow processing systems. The subsequent paper will underline the differences between the theoretical approach and our experimental efforts, and the final paper will consider potential future process configurations and areas of expected improvement.

A series of calculations is presented for the prediction of sedimentation velocities for red and white cells. The equations are simplified to investigate the regions of high red cell concentration, and are not valid for regions of concentrated platelets or white cells. The intent is to present a sample calculational design approach.
Apheresis in Rheumatoid Arthritis
Authors: Hamblin T.J.
Published: April 2018

Plasmapheresis was first introduced as a means of treating the rheumatic diseases in 1976. The rationale of its use was the removal of circulating immune complexes, thus preventing their deposition in the tissue. In rheumatoid arthritis circulating immune complexes do indeed occur and are responsible for some of the serious complications such as vasculitis. Since the T cells are implicated in tissue damage, lymphapheresis and lymphoplasmapheresis were introduced with various success rates. Controlled trials in rheumatoid arthritis have found no value for intensive plasmapheresis, limited value for lymphapheresis and possible, though suspect, value for lymphoplasmapheresis.
Visual Function in Diabetic Patients Undergoing Dialysis: Comparison of Peritoneal and Hemodialysis
Authors: Diaz-Buxo J.A. , Burgess W.P. , Greenman M. , Chandler J.T. , Farmer C.D. , Walker P.J.
Published: April 2018

A prospective, uncontrolled study was designed to evaluate the changes in visual efficiency among insulin-requiring diabetic patients undergoing peritoneal and hemodialysis. Of the 112 patients (63% adult onset and 37% juvenile onset diabetics) studied chronologically, 63% were treated with hemodialysis and 37% with peritoneal dialysis. The mean distribution of sex, age, observation period and initial visual function were the same in the peritoneal and hemodialysis subpopulations, but more juvenile onset diabetics were treated with peritoneal dialysis.

Preservation of vision correlated well with overall blood pressure control in all dialysis groups. Loss of vision was independent of the dialysis modality, of glucose control, and of the type of onset of diabetes.
Heparin for Hemodialysis: Practical Guidelines for Administration and Monitoring
Authors: Mingardi G. , Perico N. , Pusineri F. , Massazza M. , Marchesi E. , Mecca G. , Remuzzi G. , Donati M.B.
Published: April 2018

Anticoagulation of extracorporeal circuit still represents a major problem for hemodialysis units.

Uraemic patients are at risk of hemorrages, so anticoagulant could increase such a risk. On the other hand clotting of extracorporeal circuit may complicate inadequate heparin administration or hemostatic activation by the foreign surfaces.

In this article we propose a simple standard for heparin administration and monitoring which allows the theoretical best anticoagulation for extracorporeal circuit. Our data also indicate that the effect of our proposed schedule is not influenced by the type of membrane or dialyser used.
Plasma Exchange in Myasthenia Gravis
Authors: Marconi G. , Bobbi S. , Pizzi A. , Sbrilli C. , Taiuti R. , Ronchi O. , Avanzi G. , Lombardo R. , Franco C. , Biani D.
Published: April 2018

Results obtained with P.E. therapy on 19 myasthenic patients are reported. 15 of them improved during treatment and 4 remained unchanged. We believe P.E. is an useful therapy in M.G. because it produces a rapid improvement in most patients.
Plasma Exchange in Radiculopolyneuropathies
Authors: Marconi G. , Bobbi S. , Pizzi A. , Sbrilli C. , Taiuti R. , Ronchi O. , Avanzi G. , Lombardo R. , Franco C. , Biani D.
Published: April 2018

The AA. report the results obtained with Plasma Exchange (P.E.) therapy on 24 cases of polyradiculoneuritis; eleven patients had typical Guillain-Barré Syndrome (G.B.S.) ten suffered from a chronic progressive form and three were affected by a relapsing form. The acute patients were selected according to criteria established by the NNCDS Committee (1978) while guidelines laid down by Pineas & Load (1978) were followed in choosing chronic cases.

Patients with G.B.S. had four sessions of P.E. at intervals of one or two days while those with chronic forms of polyradiculoneuritis had a total of 6 sessions spaced one to three days apart. P.E. produced no apparent change in chronic progressive patients but two out of three cases with the chronic relapsing form showed rapid and steady improvement resulting in complete cure within a few months. Nine of the eleven G.B.S. patients showed after only one or two sessions a clear and rapid improvement which led to a complete cure within a matter of weeks. The remaining 2 cases showed only partial improvement at first and remained stationary thereafter.

The findings confirm the usefulness of P.E. in acute and chronic relapsing radiculopolyneuritis. However, potential side effects and the procedure's high cost suggest that its use should be limited to carefully selected cases, and in particular to those involving respiratory disorders.
Pulmonary Pathology in Renal Transplant Recipients
Authors: Fairshter R.D. , Vaziri N.D. , Farooqui S. , Martin D.
Published: April 2018

Studies of the lungs have revealed multiple functional and histopathological abnormalities in patients with chronic renal failure, but data following renal transplantation are extremely limited. We examined postmortem data from 20 transplant patients and found pulmonary abnormalities in most patients. The number of pulmonary abnormalities noted in patients with poor transplant renal function, surviving less than one year after transplantation, averaged 5.3 per patient. The corresponding number was significantly less (3.4 per patient) in the group with good transplant renal function, surviving more than one year after transplantation. Pulmonary calcification, fibrosis, and hemosiderosis were found in several patients in the former group but in none of the latter group. This observation suggests reversibility of these pulmonary abnormalities with successful renal transplantation.