bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.