[Effects of dose of erythropoiesis stimulating agents on cardiovascular outcomes, quality of life and costs of haemodialysis. the clinical evaluation of the DOSe of erythropoietins (C.E. DOSE) Trial]. / Effetti della dose degli agenti stimolanti l'eritropoiesi su esiti cardio-cerebrovascolari, qualità di vita e costi in emodialisi.

BACKGROUND: Anaemia is a risk factor for death, adverse cardiovascular outcomes and poor quality of life in patients with chronic kidney disease (CKD). Erythropoietin Stimulating Agents (ESA) are the most used treatment option. In observational studies, higher haemoglobin (Hb) levels (around 11-13 g/dL) are associated with improved survival and quality of life compared to Hb levels around 9-10 g/dL. Randomized studies found that targeting higher Hb levels with ESA causes an increased risk of death, mainly due to adverse cardiovascular outcomes. It is possible that this is mediated by ESA dose rather than haemoglobin concentration, although this hypothesis has never been formally tested. METHODS: We present the protocol of the Clinical Evaluation of the Dose of Erythropoietins (C.E. DOSE) trial, which will assess the benefits and harms of a high versus a low ESA dose therapeutic strategy for the management of anaemia of end stage kidney disease (ESKD). This is a randomized, prospective open label blinded end-point (PROBE) design trial due to enroll 900 haemodialysis patients. Patients will be randomized 1:1 to 4000 UI/week i. v. versus 18000 UI/week i. v. of epoetin alfa, beta or any other epoetin in equivalent doses. The primary outcome of the trial is a composite of cardiovascular events. In addition, quality of life and costs of these two strategies will be assessed. The study has been approved and funded by the Italian Agency of Drugs (Agenzia Italiana del Farmaco (AIFA)) within the 2006 funding plan for independent research on drugs (registered at www.clinicaltrials.gov (NCT00827021)).

[Transluminal percutaneous angioplasty of stenosis of arteriovenous fistulas; 24-month follow-up]. / Angioplastica percutanea transluminare delle stenosi di fistole artero-venose. Follow-up di 24 mesi.

Stenosis is a common cause of the functional loss of vascular shunts used in chronic hemodialysis and percutaneous transluminal angioplasty represents the elective method to correct these anomalies. A total of 42 percutaneous transluminal angioplasties were performed, with a prospective study and follow-up lasting an average of 18 months, in 32 patients with insufficient blood flow of arteriovenous fistula. In over 90% of cases the procedure restored adequate hemodynamic conditions that remained unchanged during follow-up. The authors therefore conclude that percutaneous transluminal angioplasty is an efficacious, easily performed and low-cost method that does not present major complications.

[Possibilities and limits of application of fluoride-containing varnish in caries prevention, for example, "Fluor-Protector" (2)]. / Möglichkeiten und Grenzen des Einsatzes fluoridhaltiger Lacke in der Kariesprävention am Beispiel des "Fluor-Protector" (II).

Using selected literature, the author provides an overview of the possibilities and limits of fluoride varnish application in caries prophylaxis based on the example of Fluor-Protector. He concludes, as did de Bruyn and Arends (1987), that Fluor-Protector is a safe and effective agent that can prevent caries very effectively and is also promising for use as a desensitising substance.

[Fissure sealants]. / Fissurenversiegelung.

Compared to the situation in Japan, the USA or Great Britain fissure sealing for caries prevention seems to be less popular in Switzerland. Each Swiss dentist used per year (i.e. statistical average in 1988) sealants for an amount of sfr 40.00 compared to e.g. sfr 50.00 in the USA or sfr 55.00 in Japan. The explanation may be found in the high efforts and positive results already achieved in Switzerland with other preventive measurements such as tooth cleaning and various forms of fluoridation. The three most popular brands used for fissure sealing in Switzerland in 1988 and 1989 are: Delton (market share 66% by value, 50% by weight); Helioseal (10% by value, 20% by weight); White Sealant (20% by value, 18% by weight).

Controlled trial of methylprednisolone pulses and low dose oral prednisone for the minimal change nephrotic syndrome.

In a multicentre, randomised, prospective trial 89 patients (67 children and 22 adults) with the minimal change nephrotic syndrome were treated with three intravenous pulses of methylprednisolone followed by low dose oral prednisone for six months (group given methylprednisolone) or with high dose oral prednisone for four weeks followed by low dose oral prednisone for five months (control group). Five patients in the group given methylprednisolone and one in the control group did not respond initially. The time to response was shorter in children treated with methylprednisolone. No significant differences between the two groups were observed in the number of patients who relapsed or number of relapses per patient per year. Patients given methylprednisolone tended to relapse earlier than patients in the control group. Side effects related to treatment were significantly fewer in the group given methylprednisolone than in the control group. These data suggest that a short course of methylprednisolone pulses followed by low dose oral prednisone is only marginally less effective than a regimen of high dose oral steroids but can improve the ratio of risk to benefit associated with treatment of the minimal change nephrotic syndrome.